Psychology and Psychotherapy-Theory Research and Practice最新文献_第7页

Cognitive behavioural therapy for psychosis: The end of the line or time for a new approach? 精神病的认知行为疗法：新方法的终点还是时间？

IF 3.4 3区医学 Q2 PSYCHIATRY

Psychology and Psychotherapy-Theory Research and Practice

Pub Date : 2023-10-07 DOI: 10.1111/papt.12498

Katherine Newman-Taylor, Richard Bentall

Purpose

Following its introduction in the early 1990s, cognitive behavioural therapy for psychosis (CBTp) has been evaluated in a large number of clinical trials and is now established as a recommended treatment in the UK National Health Service and elsewhere in the world. Meta-analyses, however, indicate modest effects compared to treatment as usual or comparison therapies such as supportive counselling. Here, we seek to identify factors impacting the effectiveness of CBTp, and avenues for future psychotherapy research that may improve outcomes.

Method

We outline two recent umbrella reviews and discuss factors likely to impact the effectiveness of CBTp.

Results

Modest effect sizes from meta-analyses mask heterogeneous outcomes, with some people benefiting and others possibly being harmed by therapy. Common factors such as the therapeutic alliance play an important role in determining outcomes but have been largely neglected by CBTp researchers. There is also the promise of improving outcomes by identifying and targeting the psychological mechanisms that either maintain psychotic symptoms (e.g. worry) or are causally implicated (e.g. trauma).

Conclusions

It is unlikely that everyone with psychosis will be equally responsive to the same therapeutic protocols. We need a new, personalised psychotherapy approach to CBTp research and practice, and can learn from research for anxiety and depression examining predictors of therapeutic response to inform treatment decisions. Precision psychological therapies informed by a combination of individual characteristics, common factors and a focus on specific mechanisms will require new research strategies and are likely to lead to improved outcomes for people with psychosis.

目的：自20世纪90年代初推出以来，精神病认知行为疗法（CBTp）已在大量临床试验中进行了评估，目前已被英国国家卫生服务局和世界其他地方确定为推荐治疗方法。然而，荟萃分析表明，与常规治疗或支持性咨询等比较疗法相比，效果不大。在这里，我们试图确定影响CBTp有效性的因素，以及未来可能改善结果的心理治疗研究的途径。方法：我们概述了最近的两项总括性综述，并讨论了可能影响CBTp有效性的因素。结果：荟萃分析的适度效应大小掩盖了异质性结果，一些人受益，另一些人可能受到治疗的伤害。治疗联盟等常见因素在决定结果方面发挥着重要作用，但在很大程度上被CBTp研究人员忽视了。通过识别和靶向维持精神病症状（如担忧）或与之有因果关系（如创伤）的心理机制，也有望改善结果。结论：不太可能每个精神病患者都对相同的治疗方案有同样的反应。我们需要一种新的、个性化的心理治疗方法来进行CBTp的研究和实践，并可以从焦虑和抑郁的研究中学习，检查治疗反应的预测因素，为治疗决策提供信息。结合个体特征、共同因素和对特定机制的关注，进行精确的心理治疗将需要新的研究策略，并可能改善精神病患者的预后。

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引用次数: 0

Functional neurological disorder: A qualitative study exploring individuals' experiences of psychological services 功能性神经障碍：一项探索个体心理服务体验的定性研究。

IF 3.4 3区医学 Q2 PSYCHIATRY

Psychology and Psychotherapy-Theory Research and Practice

Pub Date : 2023-10-06 DOI: 10.1111/papt.12504

Amelia Staton, David Dawson, Hannah Merdian, Anna Tickle, Tammy Walker

Objectives

Individuals with a diagnosis of FND report experiencing stigma in medical settings, however, there is a paucity of research exploring their experiences in psychological services. The aim of this research was to explore experiences of accessing UK psychological services, from the perspective of those with FND.

Methods

This study utilised a qualitative approach with data collected from semi-structured interviews (n = 15) and analysed using reflexive thematic analysis.

Results

One superordinate theme, ‘the stigmatised self within the therapeutic relationship’, and five interrelated subthemes were identified: ‘internalised stigma and self-doubt’, ‘selective disclosure to professionals’, ‘perceptions of psychological explanations’, ‘having to educate the professionals’ and ‘attunement and trust within the therapeutic relationship’. Positive therapeutic relationships were perceived to mitigate the impact of these perceived barriers. The conceptualisation of FND and the perception of how this was responded to by services and professionals was a central tenet throughout the related themes.

Conclusions

Intra-personal, interpersonal and organisational stigma impact access and engagement to psychological treatment. The findings of this study highlight the need for increased training provision for practitioners with a focus on actively challenging FND stigma within services at both an individual and systemic level.

目的：被诊断为FND的个体报告称在医疗环境中经历了耻辱，然而，很少有研究探讨他们在心理服务中的经历。本研究的目的是从FND患者的角度探讨获得英国心理服务的经历。方法：本研究采用定性方法，从半结构化访谈（n = 15）并采用反身主位分析法进行分析。结果：确定了一个上级主题“治疗关系中被污名化的自我”和五个相互关联的子主题：“内化的污名和自我怀疑”、“向专业人员选择性披露”、“对心理解释的感知”、“必须教育专业人员”和“治疗关系内的协调和信任”。积极的治疗关系被认为可以减轻这些感知障碍的影响。FND的概念化以及服务和专业人员对此的反应是贯穿相关主题的核心原则。结论：个人、人际和组织内部的污名影响获得和参与心理治疗。这项研究的结果强调了增加从业者培训的必要性，重点是在个人和系统层面积极挑战服务中的FND污名。

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引用次数: 0

An exploration of the relationship between voices, dissociation, and post-traumatic stress disorder symptoms 探索声音、分离和创伤后应激障碍症状之间的关系。

IF 3.4 3区医学 Q2 PSYCHIATRY

Psychology and Psychotherapy-Theory Research and Practice

Pub Date : 2023-10-06 DOI: 10.1111/papt.12493

Emily Piesse, Georgie Paulik, Danielle Mathersul, Lee Valentine, Ilias Kamitsis, Sarah Bendall

Objectives

Extensive research has shown voice hearing to be associated with symptoms of Post-Traumatic Stress Disorder (PTSD) and dissociation. However, most studies have adopted a quantitative design, using cross-sectional data sampling methods, precluding temporal relationships between variables from being defined.

Design

Using a qualitative design, this study sought to identify potential symptom relationships by addressing the research question: what is the nature of the temporal relationship between voices, dissociation and PTSD symptoms?

Methods

Seven voice hearers (aged 27 to 68 years) participated in a semi-structured interview exploring voice hearing, PTSD symptoms, and dissociation. The interviews were analysed using Interpretative Phenomenological Analysis.

Results

One superordinate theme was identified in the data. Voices were observed to occur in dynamic interrelationship with PTSD symptoms and dissociation, and were frequently experienced before and after PTSD symptoms and dissociative episodes.

Conclusions

Implications for theoretical understandings of voice hearing and future research are discussed.

目的：广泛的研究表明，语音听力与创伤后应激障碍（PTSD）和分离症状有关。然而，大多数研究都采用了定量设计，使用横断面数据采样方法，排除了变量之间的时间关系的定义。设计：本研究采用定性设计，试图通过解决研究问题来确定潜在的症状关系：声音、分离和创伤后应激障碍症状之间的时间关系的性质是什么？方法：7名受试者（年龄27至68岁）年）参加了一次半结构化访谈，探讨了语音听力、创伤后应激障碍症状和分离。访谈采用解释现象学分析法进行分析。结果：数据中确定了一个上级主题。观察到声音与创伤后应激障碍症状和解离有动态相互关系，并且在创伤后应激症状和解离发作前后经常出现。结论：对语音听觉的理论理解和未来的研究有一定的启示。

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引用次数: 0

Trauma therapies for psychosis: A state-of-the-art review 精神病的创伤治疗：最新进展综述。

IF 3.4 3区医学 Q2 PSYCHIATRY

Psychology and Psychotherapy-Theory Research and Practice

Pub Date : 2023-10-05 DOI: 10.1111/papt.12499

Amy Hardy, Nadine Keen, David van den Berg, Filippo Varese, Eleanor Longden, Thomas Ward, Rachel M Brand

Background

Traumatic events, particularly childhood interpersonal victimisation, have been found to play a causal role in the occurrence of psychosis and shape the phenomenology of psychotic experiences. Higher rates of post-traumatic stress disorder (PTSD) and other trauma-related mental health problems are also found in people with psychosis diagnoses compared to the general population. It is, therefore, imperative that therapists are willing and able to address trauma and its consequences when supporting recovery from distressing psychosis.

Method

This paper will support this need by providing a state-of-the-art overview of the safety, acceptability and effects of trauma therapies for psychosis.

Results

We will first introduce how seminal cognitive-behavioural models of psychosis shed light on the mechanisms by which trauma may give rise to psychotic experiences, including a putative role for trauma-related emotions, beliefs and episodic memories. The initial application of prolonged exposure and eye movement and desensitation and reprocessing therapy (EMDR) for treating PTSD in psychosis will be described, followed by consideration of integrative approaches. These integrative approaches aim to address the impact of trauma on both post-traumatic stress symptoms and trauma-related psychosis. Integrative approaches include EMDR for psychosis (EMDRp) and trauma-focused Cognitive-Behavioural Therapy for psychosis (tf-CBTp). Finally, emerging dialogic approaches for targeting trauma-related voice-hearing will be considered, demonstrating the potential value of adopting co-produced (Talking with Voices) and digitally augmented (AVATAR) therapies.

Conclusion

We will conclude by reflecting on current issues in the area, and implications for research and clinical practice.

背景：创伤事件，特别是儿童时期的人际伤害，已被发现在精神病的发生中起着因果作用，并形成了精神病经历的现象学。与普通人群相比，被诊断为精神病的人患创伤后应激障碍（PTSD）和其他与创伤相关的心理健康问题的几率也更高。因此，治疗师在支持从痛苦的精神病中康复时，必须愿意并能够解决创伤及其后果。方法：本文将通过提供精神病创伤治疗的安全性、可接受性和效果的最新综述来支持这一需求。结果：我们将首先介绍精神病的开创性认知行为模型如何揭示创伤可能导致精神病体验的机制，包括创伤相关情绪、信念和情景记忆的假定作用。将描述长期暴露和眼动以及去密度和再加工治疗（EMDR）在治疗精神病患者PTSD中的初步应用，然后考虑综合方法。这些综合方法旨在解决创伤对创伤后应激症状和创伤相关精神病的影响。综合方法包括精神病的EMDR（EMDRp）和精神病的创伤集中认知行为治疗（tf CBTp）。最后，将考虑针对创伤相关语音听力的新兴对话方法，证明采用联合制作（与语音对话）和数字增强（AVTAR）疗法的潜在价值。结论：最后，我们将反思该领域的当前问题，以及对研究和临床实践的启示。

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引用次数: 0

An exploration of the relationship between loneliness, the severity of eating disorder-related symptoms and the experience of the ‘anorexic voice’ 探索孤独感、进食障碍相关症状的严重程度和“厌食症声音”体验之间的关系。

IF 3.4 3区医学 Q2 PSYCHIATRY

Psychology and Psychotherapy-Theory Research and Practice

Pub Date : 2023-10-04 DOI: 10.1111/papt.12502

Mary-Jane Marffy, John Fox, Marc Williams

Objectives

Many individuals with eating disorders (EDs) report the experience of an ‘Anorexic voice’ (AV). Negative experiences of loneliness are also often associated with EDs. This study sought to explore the relationship between experiences of loneliness, the frequency of the AV and the impact of this on ED symptom severity.

Design

165 individuals (mean age 27.54 years) who accessed online forums relating to EDs participated in this study. The sample included individuals who have experienced an AV [AV group (N = 141)] and those who have not [non-AV group (N = 23)].

Methods

The study utilised self-report measures via an online questionnaire to explore the predictive validity of loneliness and frequency of the AV on ED symptom severity.

Results

Confirmatory analysis (AV group only) demonstrated the significance of the independent variables individually predicting ED symptom severity. However, a significant interaction was not found between the two primary variables in predicting ED symptom severity, more significantly than the influence of either variable alone. Exploratory analysis considered the differences between the two groups (AV and Non-AV), as well as considering alternate predictors.

Conclusions

The findings offer insight into possible drivers behind engagement with the AV, as part of ED presentations in the community.

目的：许多患有进食障碍（ED）的人报告了“厌食症声音”（AV）的经历。孤独的负面体验也经常与ED有关。本研究试图探索孤独体验、AV频率之间的关系，以及这对ED症状严重程度的影响。设计：165人（平均年龄27.54岁）年）参加了这项研究。样本包括经历过AV的个体[AV组（N = 141）]和没有[非AV组（N = 23）]。方法：该研究通过在线问卷使用自我报告措施来探索孤独感和AV频率对ED症状严重程度的预测有效性。结果：证实性分析（仅AV组）证明了自变量单独预测ED症状严重程度的重要性。然而，在预测ED症状严重程度方面，两个主要变量之间没有发现显著的相互作用，比单独两个变量的影响更显著。探索性分析考虑了两组（AV和非AV）之间的差异，并考虑了替代预测因素。结论：这些发现提供了对AV参与背后可能的驱动因素的见解，作为ED在社区中介绍的一部分。

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引用次数: 0

What does it mean to age well with bipolar disorder? A qualitative study using photo elicitation 患有双相情感障碍意味着什么？使用照片启发的定性研究。

IF 3.4 3区医学 Q2 PSYCHIATRY

Psychology and Psychotherapy-Theory Research and Practice

Pub Date : 2023-09-25 DOI: 10.1111/papt.12501

Aaron Warner, Fiona Lobban, Carol Holland, Elizabeth Tyler, Geoff Settle, Verity Rhodes, Jasper Palmier-Claus

Objectives

The objective of this study is to explore what ageing well means to older adults with bipolar disorder.

Methods

Older adults with bipolar disorder took photographs of aspects of their lives that they felt represented ageing well. They then completed audio-recorded photo elicitation interviews to explore what it meant to age well with bipolar disorder in detail. Data were analysed using reflexive thematic analysis.

Results

Seventeen participants met the criteria for bipolar disorder I or II. The analysis resulted in four key themes to ageing well with bipolar disorder: (1) Lifelong learning – referring to how participants accumulated a wealth of knowledge about bipolar disorder and used this to maintain stability in later life; (2) Finding where you belong – relating to how participants prioritised finding new communities, utilised family support and refined their support networks over time to age well; (3) Recognising your value and worth – which involved participants using their strengths and experiences to support others; and (4) Continuity of support – older adults with bipolar disorder highlighted the benefits of continuous support that allowed them to be actively involved in their treatment.

Conclusions

Participants ageing with bipolar disorder identified unique challenges indicating that services require adaptation to meet their needs and support them to age well. Findings suggested that services should provide continuous care that allows this group to actively engage with their treatment, build upon their strengths, and develop meaningful connections with professionals and peers. This approach may enhance support for older adults with bipolar disorder and reduce the inequalities they experience.

目的：本研究的目的是探讨衰老对患有双相情感障碍的老年人意味着什么。方法：患有双相情感障碍的老年人拍摄他们生活中的一些方面的照片，他们觉得这些方面很好地代表了衰老。然后，他们完成了录音照片启发访谈，详细探讨双相情感障碍患者的衰老意味着什么。使用反射性主题分析对数据进行分析。结果：17名参与者符合双相情感障碍I或II的标准。该分析得出了四个关于双相情感障碍患者良好衰老的关键主题：（1）终身学习——指的是参与者如何积累关于双相精神障碍的丰富知识，并利用这些知识在以后的生活中保持稳定；（2）寻找你的归属——与参与者如何优先寻找新的社区、利用家庭支持以及随着时间的推移完善他们的支持网络以适应良好的年龄有关；（3）认识到你的价值和价值——参与者利用自己的优势和经验来支持他人；以及（4）支持的连续性-患有双相情感障碍的老年人强调了持续支持的好处，使他们能够积极参与治疗。结论：患有双相情感障碍的老年参与者发现了独特的挑战，这表明服务需要适应以满足他们的需求并支持他们健康衰老。研究结果表明，服务应提供持续的护理，使这一群体能够积极参与他们的治疗，发挥他们的优势，并与专业人士和同行建立有意义的联系。这种方法可以加强对患有双相情感障碍的老年人的支持，并减少他们所经历的不平等。

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引用次数: 0

Investigating associations between self-compassion, self-criticism and psychotic-like experiences 调查自我同情、自我批评和类似精神病的经历之间的联系。

IF 3.4 3区医学 Q2 PSYCHIATRY

Psychology and Psychotherapy-Theory Research and Practice

Pub Date : 2023-09-25 DOI: 10.1111/papt.12500

Siobhan Collman, Charles Heriot-Maitland, Emmanuelle Peters, Oliver Mason

Objectives

Dimensional approaches suggest psychotic symptoms exist along a continuum, with psychotic-like experiences (PLEs) being an expression of a non-clinical psychosis phenotype. Existing research indicates self-criticism may contribute to symptom maintenance, frequency and distress, whereas self-compassion may act protectively. Associations between self-criticism, self-compassion and PLEs in the general population have received less attention. The present study sought to investigate these associations. It was hypothesised that PLE endorsement would be associated positively with self-criticism and negatively with self-compassion.

Design

Quantitative cross-sectional study. Data collected via an online questionnaire.

Methods

Five hundred thirty-one participants completed the Self-Compassion Scale (Short Form), the Forms of Self-Criticising/Attacking and Self-Reassuring Scale and the Transpersonal Experiences Questionnaire. Individuals with a psychosis-related diagnosis were excluded. The data were analysed using linear regression, accounting for the effects of demographic variables.

Results

Self-criticism subtype self-hatred was associated with PLEs. Subtype self-inadequacy was not. No association was found between self-compassion and PLEs. Educational attainment was negatively associated with PLE endorsement.

Conclusions

Self-criticism, but not self-compassion, is associated with PLE endorsement, suggesting they are separate factors with different relationships to PLEs. Further research is needed to confirm the direction of the interaction. Either way, psychological interventions (where needed) could target self-criticism and may be important in assessing psychosis risk.

目的：维度方法表明精神病症状是连续存在的，精神病样经历（PLEs）是非临床精神病表型的一种表达。现有研究表明，自我批评可能有助于症状的维持、频率和痛苦，而自我同情可能起到保护作用。在普通人群中，自我批评、自我同情和PLE之间的联系受到的关注较少。本研究试图调查这些关联。假设PLE认可与自我批评呈正相关，与自我宽容负相关。设计：定量横断面研究。通过在线问卷收集的数据。方法：531名参与者完成了自我同情量表（简表）、自我批评/攻击和自我安慰量表和跨个人经历问卷。有精神病相关诊断的个体被排除在外。使用线性回归对数据进行分析，考虑到人口统计变量的影响。结果：自我批评亚型自我憎恨与PLEs相关。亚型自我缺陷不是。在自我同情和PLEs之间没有发现关联。受教育程度与PLE认可呈负相关。结论：自我批评而非自我同情与PLE认可有关，表明它们是与PLE有不同关系的独立因素。需要进一步的研究来确认相互作用的方向。无论哪种方式，心理干预（必要时）都可以针对自我批评，并可能对评估精神病风险很重要。

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引用次数: 0

The Reflective Fostering Programme—Adapting a group parenting programme for online delivery in response to the COVID-19 pandemic in the United Kingdom 反思性养育计划-为应对英国新冠肺炎疫情，将集体养育计划调整为在线分娩。

IF 2.6 3区医学 Q2 PSYCHIATRY

Psychology and Psychotherapy-Theory Research and Practice

Pub Date : 2023-09-20 DOI: 10.1111/papt.12497

Sheila Redfern, Benita Pursch, Thando Katangwe-Chigamba, Rumour Sopp, Karen Irvine, Eva A. Sprecher, Theresa Schwaiger, Nick Midgley

Objective

In the context of the Covid-19 pandemic and subsequent lockdown restrictions, service providers faced significant challenges in delivering programmes to support their vulnerable service users. Foster carers-an already often isolated group of caregivers - were offered an adapted remote-delivery model of the Reflective Fostering Programme (Redfern et al., Adopt. Foster., 42, 2018, 234) from March 2020.

Method

This paper outlines the adaptation process of the original programme to online-remote delivery and describes the feedback from participants in the programme.

Results

The adaptation of the Reflective Fostering programme to online, remote delivery had both strengths and weaknesses - including wider access to foster carers who might struggle to attend in person and challenge a to maintaining a Mentalizing space online and ensuring confidentiality within a therapeutic space. The programme was overwhelmingly well received by foster carers in this format.

Conclusions

There are opportunities and challenges in the delivery of online therapeutic services, particularly those with a group format. This paper contributes initial reflections to what we hope will be a rapidly developing literature on best practice of supporting group services in an online format.

目标：在新冠肺炎大流行和随后的封锁限制的背景下，服务提供商在提供支持弱势服务用户的计划方面面临重大挑战。从2020年3月起，寄养照料者——一个已经经常被孤立的照料者群体——被提供了一个经过调整的反思性寄养计划的远程交付模式（Redfern et al.，Adopt.Fester.，422018234）。方法：本文概述了原始计划对在线远程交付的适应过程，并描述了该计划参与者的反馈。结果：将反思性寄养计划调整为在线远程交付既有优点也有缺点，包括更广泛地接触可能难以亲自参加的寄养照顾者，并挑战保持在线心理空间和确保治疗空间内的保密性。该方案在这种形式的寄养照顾者中获得了压倒性的好评。结论：在提供在线治疗服务方面存在机遇和挑战，特别是那些采用团体形式的服务。本文对我们希望迅速发展的以在线形式支持团体服务的最佳实践文献进行了初步思考。

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引用次数: 0

Outcomes for Adaptive Mentalization Based Integrative Treatment informed care for adolescents using a deployment-based approach 采用基于部署的方法为青少年提供基于适应性心理化的综合治疗成果。

IF 2.6 3区医学 Q2 PSYCHIATRY

Psychology and Psychotherapy-Theory Research and Practice

Pub Date : 2023-09-15 DOI: 10.1111/papt.12496

Peter Fuggle, James Fairbairn, Peter Fonagy

Purpose

Adolescent mentalisation-based integrative therapy (AMBIT) is a whole-systems approach designed to enhance the effectiveness and coordination of care for clients experiencing severe and pervasive difficulties in social and health care settings, who have not responded to traditional clinical approaches. AMBIT is a team-based manualised method that primarily aims to bolster mental state understanding and discourse focused on the client within and between teams. Over 300 teams worldwide have been trained in and adhere to AMBIT principles.

Method

In this paper, we review and summarise the outcomes reported by eight AMBIT-informed teams that have published their findings with young people. Each report is discussed, and limitations of the data provided are identified.

Results

A synthesis of the findings across the studies suggests a generally positive impact of teams informed by AMBIT with moderate to large effect sizes on reducing symptoms and improving functionality.

Conclusions

This study suggests that AMBIT may be a promising approach for young people with multiple problems but further research is needed to identify the active mechanisms of change in complex helping systems.

目的：基于青少年心理化的综合疗法（AMBIT）是一种全系统方法，旨在提高护理的有效性和协调性，以帮助那些在社会和健康护理环境中遇到严重和普遍困难、对传统临床方法没有反应的客户。AMBIT 是一种以团队为基础的手册化方法，主要目的是加强团队内部和团队之间对客户心理状态的理解和讨论。全球已有 300 多个团队接受了 AMBIT 原则的培训，并遵循该原则：在本文中，我们回顾并总结了八个以 AMBIT 为基础的团队所报告的结果，这些团队已经公布了他们对年轻人的研究结果。我们对每份报告进行了讨论，并指出了所提供数据的局限性：结果：对各项研究结果的综述表明，以 AMBIT 为指导的团队在减少症状和改善功能方面普遍产生了积极的影响，其效应大小为中等到较大：本研究表明，对于存在多种问题的年轻人来说，AMBIT 可能是一种很有前途的方法，但还需要进一步研究，以确定复杂帮助系统中的积极变化机制。

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引用次数: 0

Establishing an optimal working relationship with patients with an antisocial personality disorder. Aspects and processes in the therapeutic alliance 与反社会人格障碍患者建立最佳工作关系。治疗联合的各个方面和过程。

IF 3.4 3区医学 Q2 PSYCHIATRY

Psychology and Psychotherapy-Theory Research and Practice

Pub Date : 2023-09-06 DOI: 10.1111/papt.12492

J. E. M. Aerts, M. J. N. Rijckmans, S. Bogaerts, A. van Dam

Objective

Developing good interpersonal relationships is one of the main impediments for people with an antisocial personality disorder (ASPD). However, in treatment of psychiatric disorders, establishing a strong therapeutic alliance (TA) is important for effective treatment. Nevertheless, there is little knowledge on how to establish this TA with this challenging patient group. This study investigates which factors are important in TA development.

Method

For this study, a qualitative research methodology is applied. In-depth interviews with therapists experienced in treating ASPD were conducted and analysed through thematic analysis.

Results

The analysis revealed six themes important in alliance formation: the patient's needs, regulating interpersonal dynamics, connective attitude, connective skills, treatment process and treatment goals. Each theme is defined including aspects of the recommended therapeutic attitude and required skills for therapists working with patients with ASPD.

Conclusions

This study determined that, for therapists working with patients with ASPD, several key factors are essential in establishing a strong TA. These factors include the ability to be firm, authentic, non-judgmental and genuinely involved. An attentive presence is crucial, in which the therapist takes initiative in establishing contact and makes the patient feel that he is truly seen as an autonomous and equal person. In doing so, the therapist needs to provide clarity and structure while remaining perceptive to boundary violations. The therapist must be able to set limits using a clear yet kind tone of voice. Furthermore, it was notable that an intensive appeal is made to the therapist's reflective capacity in these treatments.

目的：发展良好的人际关系是反社会人格障碍（ASPD）患者的主要障碍之一。然而，在精神障碍的治疗中，建立强有力的治疗联盟（TA）对有效治疗很重要。然而，对于如何与这一具有挑战性的患者群体建立这种TA，却知之甚少。本研究调查了TA发展中哪些因素是重要的。方法：本研究采用定性研究方法。对有治疗ASPD经验的治疗师进行了深入访谈，并通过主题分析进行了分析。结果：分析揭示了联盟形成中的六个重要主题：患者的需求、调节人际动态、联系态度、联系技能、治疗过程和治疗目标。每一个主题都被定义为包括治疗ASPD患者的治疗师的推荐治疗态度和所需技能。结论：本研究确定，对于治疗ASPD的治疗师来说，几个关键因素对于建立强大的TA至关重要。这些因素包括坚定、真实、不带偏见和真诚参与的能力。专注的存在是至关重要的，在这种情况下，治疗师会主动建立联系，让患者感觉到自己真正被视为一个自主和平等的人。在这样做的过程中，治疗师需要提供清晰和结构，同时对边界侵犯保持敏锐的洞察力。治疗师必须能够用清晰而亲切的语调设定限制。此外，值得注意的是，治疗师在这些治疗中的反思能力受到了强烈的呼吁。

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