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The most important lesson that I have learned in my half century as a therapist (and therapy researcher) is that principles matter more than processes. I had the great good fortune to arrive in Philadelphia at a time when Beck and colleagues were just beginning to test the efficacy of cognitive therapy for depression and what I learned was that helping clients (and myself) get the better of depression involved two main principles: (1) when in doubt do whatever you would have done if you were not depressed (behavioral); and (2) do not believe everything you think - check it out (cognitive). A third major principle is that the most powerful way to test an existing belief is to use one's own behaviors to test its accuracy, which usually means doing whatever you least want to do in that situation (opposite action). I find that focusing on these principles is wholly liberating in the therapy process; I am free to be myself, to follow any line of inquiry, to respond to any request and to comport myself much as I would with any friend outside of therapy. This focus on principles has been good for my clients and even better for me. [ABSTRACT FROM AUTHOR]

The current cross-sectional study aimed to explore burnout in psychotherapists and its associated factors. Certificated psychotherapists and counsellors aged between 20 and 65 were eligible to participate in the present study, and a final sample of 177 psychotherapists and counsellors was obtained. The mean age of participants was 40.32 years (SD = 9.56), and the majority of them were female (142, 80.2%). Participants completed an online survey through a mobile application, including demographics (e.g., age, gender, etc.), workload (the Areas of Worklife Survey), empathy (the Basic Empathy Scale), self-compassion (the Self-Compassion Scale short form), and burnout (the Maslach Burnout Inventory—General Survey). Investigations were conducted to examine self-compassion as a moderator and empathy dimensions as mediators between workload and burnout dimensions. The results confirmed that the associations between workload and emotional exhaustion/cynicism were mediated by emotional contagion, and the association between workload and professional efficacy was mediated by cognitive empathy. However, self-compassion did not buffer the association between workload and burnout dimensions. The findings of the current study indicated that psychotherapists with heavier workloads were more likely to be emotionally contagious and experienced higher emotional exhaustion and cynicism, while their cognitive empathy was also likely to be impaired and experienced lower professional efficacy. Receiving regular supervision might contribute to their professional efficacy. [ABSTRACT FROM AUTHOR]

The recall of memories of past events, experiences and emotions is a complex process. When experiencing traumatic events, as is the case with sexual violence, a host of additional complexities and difficulties arise. This becomes especially important in court cases which rely mostly or exclusively on the testimony of the victim, where the problem of the fallibility of memory takes center stage. Some research studies emphasize the possibility of inducing, altering or suppressing memories, especially in the context of psychotherapy. This has led to the unfortunate reality that the testimony of victims who have undergone psychotherapy is often considered to be unreliable. This in turn can lead to the impression that a decision has to be made between treatment of the adverse effects of traumatic events and maximizing the chances for a conviction of the perpetrator in court. This article introduces some central concepts of our current understanding of memory and gives an overview of the relevant scientific literature and debate. Following this, it examines the dilemma as it pertains to the different groups of all involved parties (i.e., victims, members of the judiciary and psychotherapists). Lastly, it proposes a framework of how to approach a solution to this problem by focusing on research in critical areas, expansion of therapy guidelines and documentation procedures as well as communication of these efforts to all parties involved. [ABSTRACT FROM AUTHOR]

The principles of CBT emphasize the interactions among cognition, emotion, and behavior. CBT's origins lie in Stoicism philosophy and share similarities with the ideas of Confucianism, Taoism, and Traditional Chinese Medicine (TCM) in China. The idea of mind–body regulation in traditional Chinese culture has laid a cultural foundation for the promotion of CBT in China. This paper analyzes the applicability and challenges of CBT in China based on the current development of CBT in mainland China and the learning and practice of CBT therapists. It also explores the potential further development of CBT in China and the integration of CBT with the Chinese culture. [ABSTRACT FROM AUTHOR]

Opioid use disorder (OUD) is characterized by a lack of control in opioid use, resulting in psychological distress and deficits in interpersonal and social functioning. OUD is often associated with psychiatric comorbidities that increase the severity of the disorder. The consequences of OUD are dramatic in terms of increased morbi-mortality. Specific medications and psychotherapies are essential tools not only in the treatment of OUD but also in the prevention of suicide and overdoses. In our review, we assess the different types of psychotherapies (counseling, motivational interviewing, contingency management, cognitive-behavioral therapy, and dialectical-behavior therapy) that are delivered to opioid users, either associated or un-associated with OUD medications and/or medications for psychiatric disabilities. We describe the application of these therapies first to adult opioid users and then to adolescents. This work led us to propose a stepped-care model of psychotherapies for OUD which provided information to assist clinicians in decision-making regarding the selection of psychotherapeutic strategies according to patients' OUD severity. [ABSTRACT FROM AUTHOR]

Deep dyspareunia is one of the main symptoms of endometriosis. It appears to be submerged by a two-way disconnection between patients and their physicians. The aim of our review is to provide clear, ready-to-use advice on how to manage deep dyspareunia overcoming the gap in communication. Sexual history should always be taken as part of routine health care in these regards, using a patient-centered approach. An educational pelvic examination, which actively includes patients in the identification of painful areas, may prove useful to improve patients' understanding of their condition. Correlating painful pelvic areas with sexual positions and inviting patients to adopt alternative positions may represent a simple but extremely effective coping strategy to mitigate pain. Revealing and explaining to partners the nature of the pain is essential to allow them to take part in shared research of coping mechanisms, empowering the couple to make choices and changes. Couples who do not feel comfortable talking about intimacy by themselves may find that including a psychotherapist or a sexual therapist, may be a good way to start communication. Investigating and managing dyspareunia during medical encounters is a medical and ethical duty all healthcare practitioners should pursue. [ABSTRACT FROM AUTHOR]

This document introduces a special issue on technological applications in mental health and mental health services research. The advancements in computer technology have allowed for innovative applications in collecting and analyzing data related to mental health. The use of personal electronic devices and the internet provides a rich stream of data that can offer insights into individuals' mental health. The special issue includes papers on topics such as video therapy, measurements in daily life, and automated coding of psychotherapy sessions. These papers highlight the potential of technology in improving mental health outcomes and expanding the accessibility of mental health services. [Extracted from the article]

This research focused on the intricacies of mental health within the psychotherapist community, a domain currently understudied. A recent study suggests a better overall mental health profile for Austrian psychotherapists compared to the general population. However, a substantial proportion of psychotherapists still exhibited scores beyond the cut-off for clinically significant mental disorders, potentially undermining the efficacy of patient outcomes. A cross-sectional study was conducted between April to June 2023, enrolling a cohort of 502 Austrian psychotherapists (79.7% female; mean age: 53.4 ± 9.26 years). The analysis leveraged indicators for symptoms of depression (PHQ-2), anxiety (GAD-2), insomnia (ISI-2), stress (PSS-4), and overall well-being (WHO-5). Key correlations were revealed using multivariable logistic regressions incorporating sociodemographic, work-related, and health behavior variables. Mental health symptoms in psychotherapists were associated with lower income, lesser physical activity, employment in outpatient facilities, less experience in the field, and a smaller patient load. Notably, physical activity emerged as a significant protective component, underscoring regular exercise as a vital self-care routine for psychotherapists. Adequate income also presented as a crucial contributor to mental health stability. These findings augment our understanding of the complex dynamics influencing psychotherapists' mental health, potentially enhancing their well-being and optimizing professional output. [ABSTRACT FROM AUTHOR]

Objectives: Buddhist non-attachment has been shown to be effective for improving mental health and wellbeing. Non-attachment refers to the ability to engage with phenomena without psychologically clinging to experiences or rejecting them. The present qualitative investigation sought to compare secular and Buddhist-informed counselors' and psychotherapists' perceptions of the non-attachment construct, including their views on its relevance for client-therapist practice. Method: Two data sets were collected. In Sample 1, semi-structured interviews were administered to nine qualified counselors and psychotherapists with limited prior knowledge of non-attachment or related Buddhist principles. In Sample 2, five Buddhist-informed counselors and psychotherapists completed an open questionnaire. Both data sets were analysed using Reflexive Thematic Analysis. Results: Analysis of the first sample generated four themes concerning participants' understanding of non-attachment: (1) misunderstanding non-attachment, (2) who non-attachment might be useful for, (3) potential impact on the therapeutic relationship and (4) the importance of experiential understanding on the part of the therapist. The analysis of Sample 2 generated two themes: (1) considerations for assimilating non-attachment, and (2) positive experiences of applying the construct in client-therapist contexts. Conclusions: The secular mental health practitioners in Sample 1 recognised the potential utility of non-attachment but harboured some misunderstandings as to its meaning as well as reservations regarding its suitability for all client groups. This was in contrast to Sample 2 participants, who felt that with appropriate therapeutic skill and discernment, non-attachment can be beneficial for a broad range of mental health conditions. Raising awareness of non-attachment amongst secular mental health practitioners is crucial to improving comprehension of the concept and its integration into client-therapist settings. Preregistration: This study was not preregistered. [ABSTRACT FROM AUTHOR]

Evidence-based and person-centred care requires the measurement of treatment outcomes that matter to youth and mental health practitioners. Priorities, however, may vary not just between but also within stakeholder groups. This study used Q-methodology to explore differences in outcome priorities among mental health practitioners from two countries in relation to youth depression. Practitioners from the United Kingdom (UK) (n = 27) and Chile (n = 15) sorted 35 outcome descriptions by importance and completed brief semi-structured interviews about their sorting rationale. By-person principal component analysis (PCA) served to identify distinct priority profiles within each country sample; second-order PCA examined whether these profiles could be further reduced into cross-cultural "super profiles". We identified three UK outcome priority profiles (Reduced symptoms and enhanced well-being; improved individual coping and self-management; improved family coping and support), and two Chilean profiles (Strengthened identity and enhanced insight; symptom reduction and self-management). These could be further reduced into two cross-cultural super profiles: one prioritized outcomes related to reduced depressive symptoms and enhanced well-being; the other prioritized outcomes related to improved resilience resources within youth and families. A practitioner focus on symptom reduction aligns with a long-standing focus on symptomatic change in youth depression treatment studies, and with recent measurement recommendations. Less data and guidance are available to those practitioners who prioritize resilience outcomes. To raise the chances that such practitioners will engage in evidence-based practice and measurement-based care, measurement guidance for a broader set of outcomes may be needed. [ABSTRACT FROM AUTHOR]

Negative Symptoms (NS) severely affect real-world functioning also in young people at UHR for developing psychosis. However, longitudinal research on beneficial effects of specialized treatments for NS in UHR people is still relatively scarce and inconclusive, especially in real-world care settings. The aims of the present research were: (1) to evaluate the longitudinal stability of NS levels in young UHR subjects treated within a specialized "Early Intervention in Psychosis" (EIP) program across a 2-year follow-up period, and (2) to investigate any relevant association of NS changes with the specific treatment components offered within the EIP program. One hundred UHR individuals (aged 12–25 years) completed the Positive And Negative Syndrome Scale (PANSS). A multiple linear regression analysis was conducted to examine significant associations between longitudinal changes in NS severity levels and the EIP treatment components. Across the follow-up, a significant decrease in NS clinical severity was observed. This reduction was associated with the intensity of individual psychotherapy sessions provided in the first year of treatment, a shorter duration of untreated illness at entry and the 2-year longitudinal decrease in positive symptom levels. In conclusion, NS are relevant in UHR people, but decrease over time together with the delivery of specialized EIP interventions. Specifically, our results showed that individual psychotherapy may reduce the clinical severity of NS at least during the first year of treatment. [ABSTRACT FROM AUTHOR]

The new psychotherapists' law in Germany requires that future studies in psychotherapy enable students to evaluate the evidence base of psychotherapeutic methods based on established criteria. This article summarizes and applies the most important national and international criteria for evaluating the evidence base of psychodynamic psychotherapy including the criteria detailed in the Methods Paper of the Scientific Advisory Board Psychotherapy in Germany, the internationally influential criteria by Chambless et al. (1998) as well as the most recent criteria by Tolin et al. (2015). Criticism of the criteria for evidence assessment (e.g., the disorder-specific approach), current controversies (e.g., concerning the evidence base of long-term psychodynamic therapy and analytic psychotherapy, integrative psychotherapy frameworks versus specific treatment approaches), and the relevance of the participation of practicing psychodynamic psychotherapists in research projects are addressed. For the adequate assessment of the efficacy/effectiveness of psychodynamic psychotherapy, especially long-term psychodynamic therapy and analytic psychotherapy, it is necessary to include longer follow-up periods and also to assess changes in accordance with psychodynamic assumptions about therapeutic change processes. [ABSTRACT FROM AUTHOR]

Collusion is a specific and potentially harmful transference-countertransference interaction. At its core is an unconscious, unresolved issue shared by two or more participants, who are interlocked in a defensive maneuver. The issue at stake, which is avoided at the intrapsychic level, externalized, and circulating in the interpersonal space, may pertain to control, intimacy, loss, or domination, among other possibilities. Collusion occurs not only in psychoanalysis, psychotherapy, psychiatry, and medicine but also in couples and both within and between groups. This critical narrative review is based on a comprehensive consultation of the literature and our experiences as psychotherapists, supervisors, and researchers. We situate and delineate collusion, engage in a critical dialog with the literature and question some conceptual aspects of collusion. The aim of this review is to stimulate the interest of clinicians, supervisors, and researchers in this somewhat neglected phenomenon and to demonstrate and illustrate the challenges and pitfalls that clinicians face in collusive encounters. Finally, we provide clues to identify and ways of working through collusion in the context of psychotherapy and supervision. [ABSTRACT FROM AUTHOR]

Autistic youth have an increased risk of mental health problems. Despite the efficacy of various psychotherapeutic approaches for autistic youth, they often do not receive these interventions. Research is needed to identify patterns of effective treatment for autistic youth and whether they differ from those used for youth with other neurodevelopmental conditions (e.g., attention-deficit hyperactivity disorder; ADHD). We compared clinicians' (N = 557) knowledge, confidence and practices when treating autistic youth and youth with ADHD. Although ratings were moderately high overall and similar interventions were used for both groups, clinicians were significantly less knowledgeable and confident when supporting autistic clients compared to clients with ADHD. Thus, improving clinician perspectives may help facilitate treatment for autistic youth with mental health problems. [ABSTRACT FROM AUTHOR]

The implementation status of clinical guidelines is, despite their important role in connecting research with practice, frequently not satisfactory. This study aims to investigate the implementation status of the current German guideline for schizophrenia. Moreover, the attitude toward a living guideline has been explored for the first time by presenting screenshots of the German schizophrenia guideline transferred to a digital living guideline format called MAGICapp. A cross-sectional online survey was performed under the participation of 17 hospitals for psychiatry and psychosomatic medicine in Southern Germany and one professional association for German neurologists and psychiatrists. 439 participants supplied sufficient data for analysis. 309 provided complete data sets. Regarding the current guideline for schizophrenia and key recommendations, a large awareness-to-adherence gap was found. Group comparisons between different professions (caregivers, medical doctors, psychologists/psychotherapists, psychosocial therapists) detected differences in the implementation status showing higher awareness and agreement with the schizophrenia guideline and its key recommendations among medical doctors compared to psychosocial therapists and caregivers. Moreover, we detected differences in the implementation status of the guideline as a whole and its key recommendations between specialist and assistant doctors. The attitude toward an upcoming living guideline was mostly positive, especially among younger healthcare professionals. Our findings confirm an awareness-to-adherence gap, not only for the current schizophrenia guideline in general but also for its key recommendations with apparent differences between professions. Overall, our results show promising positive attitudes toward the living guideline for schizophrenia among healthcare providers, suggesting that a living guideline may be a supportive tool in everyday clinical practice. [ABSTRACT FROM AUTHOR]

School-based mental health services (SMHS) offer a unique opportunity to embed support within a key developmental context, yet little research has examined SMHS providers' fit within schools' complex ecologies. Using a social-ecological framework, this qualitative study draws on focus groups with 67 SMHS providers from two large mental health systems to examine how school setting characteristics and interactions with school actors influenced their experiences providing SMHS. Thematic analysis revealed the importance of feeling valued by and connected to school staff, which facilitated strong ongoing communication and more effective collaboration. Providers described a flexible approach to communication and collaboration, including leveraging opportunities for informal conversation (e.g., in hallways or classrooms) to overcome barriers and boost their perceived value and connectedness. Opportunities for communication and connectedness were enhanced when providers worked in fewer schools, held roles on interdisciplinary teams, spent time in common spaces, when school staff shared providers' understanding of mental health and SMHS, and when school policies and structural features facilitated their inclusion. Providers also discussed the variety of factors, including their place in the school ecology, that informed student wellbeing (e.g., disciplinary versus supportive responses to challenging student behaviors). This study suggests potential mechanisms on individual, school, and district levels to strengthen SMHS providers' value and connectedness within the school ecology, and the importance of these factors to maintain strong communication and collaboration and effectively support youth and families. [ABSTRACT FROM AUTHOR]

Background: Persons who experience homelessness (PEH) have high rates of depression and incur challenges accessing high-quality health care. Some Veterans Affairs (VA) facilities offer homeless-tailored primary care clinics, although such tailoring is not required, within or outside VA. Whether services tailoring enhances care for depression is unstudied. Objective: To determine whether PEH in homeless-tailored primary care settings receive higher quality of depression care, compared to PEH in usual VA primary care. Design: Retrospective cohort study of depression treatment among a regional cohort of VA primary care patients (2016–2019). Participants: PEH diagnosed or treated for a depressive disorder. Main Measures: The quality measures were timely follow-up care (3 + completed visits with a primary care or mental health specialist provider, or 3 + psychotherapy sessions) within 84 days of a positive PHQ-2 screen result, timely follow-up care within 180 days, and minimally appropriate treatment (4 + mental health visits, 3 + psychotherapy visits, 60 + days antidepressant) within 365 days. We applied multivariable mixed-effect logistic regressions to model differences in care quality for PEH in homeless-tailored versus usual primary care settings. Key Results: Thirteen percent of PEH with depressive disorders received homeless-tailored primary care (n = 374), compared to usual VA primary care (n = 2469). Tailored clinics served more PEH who were Black, who were non-married, and who had low income, serious mental illness, and substance use disorders. Among all PEH, 48% received timely follow-up care within 84 days of depression screening, 67% within 180 days, and 83% received minimally appropriate treatment. Quality metric attainment was higher for PEH in homeless-tailored clinics, compared to PEH in usual VA primary care: follow-up within 84 days (63% versus 46%; adjusted odds ratio [AOR] = 1.61, p =.001), follow-up within 180 days (78% versus 66%; AOR = 1.51, p =.003), and minimally appropriate treatment (89% versus 82%; AOR = 1.58, p =.004). Conclusions: Homeless-tailored primary care approaches may improve depression care for PEH. [ABSTRACT FROM AUTHOR]

Objectives: Research exploring how mindfulness is conceptualized and applied in Western psychotherapeutic settings is in its early stages. The current study examines the influence of psychotherapists' personal practice of mindfulness meditation on their professional work. Methods: Psychotherapists who identify as mindfulness teachers were interviewed about their motivation to practice mindfulness practice and how they apply it in both their personal lives and professional psychotherapeutic practice. Grounded theory was used to collect and analyze the data. Results: The study's findings revealed themes relating to motivation, practices, and therapeutic application of mindfulness which differed among the therapists. Participants were motivated to practice mindfulness meditation based on a utilitarian approach or based on a wider approach, which comprised both a utilitarian and a more contemplative motivation to practice. Importantly, we found that how psychotherapists practiced mindfulness meditation, whether from a utilitarian or contemplative approach, was related to how they used and taught it in their psychotherapeutic practices. Conclusions: The study's findings suggest a link between the personal and professional practice of mindfulness meditation by psychotherapists. Future research is needed to further investigate this link and to determine its impact on client outcomes. [ABSTRACT FROM AUTHOR]

The development of psychological disorders has been explained by several psychological theories and remains under debate. Psychotherapists, however, have insights into the emergence and development of psychological disorders that stem from both theory and practice. The constantly evolving field of psychotherapy prompts reconsideration, specifically when psychotherapists' views on the development of disorders impacts their treatment approach. In addition, theoretical orientation and years of clinical experience, while known to influence psychotherapists' viewpoints also merit further study. Applying Erving Goffman's frame analysis, semi structured interviews with psychotherapists were conducted to determine their perspectives on the emergence of mental disorders. Biological, environmental, and psychological factors were mentioned both separately and in combination by the therapists. These factors, or frames, were then analyzed in relation to the therapists' therapeutic approaches and length of clinical experience. The analysis showed that the frames employed by the therapists were influenced by several therapeutic orientations. Moreover, therapists with more than ten years of clinical experience mentioned a combination of factors slightly more often than single factors alone. In sum, the findings showed that therapists perceived the development of mental disorders as highly complex and as an outcome of multiple factors. War was also mentioned as an environmental factor in the development of mental disorders. As this finding was clearly a country-specific environmental factor, future studies should explore the possible role of country-specific environmental factors in different countries. [ABSTRACT FROM AUTHOR]

Compared to clients' personality and perspectives in psychotherapy (e.g., preferences), less research characterizes mental healthcare providers (i.e., those who have provided direct mental healthcare services). Prior work finds that provider personality configurations are unique relative to other professions, and provider perspectives of clients differ as a function of their own and their client's personality. The current study expands this literature by utilizing trait and profile-level analyses in a sample of 176 mental healthcare providers (largely US-based). Profile-level findings demonstrated that most providers were high in agreeableness and conscientiousness. When compared to a normative sample, providers demonstrated higher trait-level agreeableness and neuroticism and lower conscientiousness. Providers' preferences regarding the personality of potential clients were also explored, and these findings indicated that some providers prefer a client with personality traits similar to their own. At the profile level, most providers preferred clients who had (1) high agreeableness and conscientiousness and low neuroticism or (2) average across traits. This preliminary examination can stimulate research regarding the impact of providers' individual differences on psychotherapy. [ABSTRACT FROM AUTHOR]

Anxiety disorders (ADs) are among the most common psychiatric disorders and they may appear as early on as in childhood. The current study addressed the combination of two treatments approaches for ADs: Dance/movement therapy (DMT) and cognitive behavioral therapy (CBT), focusing on factors that explain the therapists' attitudes towards actually combining the two therapies. The study utilized a quantitative design, with a perceptions survey administered via an online questionnaire. Ninety-nine therapists participated in the study (DMT-only n = 35, CBT-only n = 42, and DMT + CBT, n = 22). Following preliminary analysis (comparison between the groups, correlations and factor analysis), the structural equation model (SEM, confirmatory factor analysis) revealed a good fit between the theoretical model and the empirical data. First, it was found that the reported actual use of the combined approaches (DMT + CBT) in treatment of children with ADs, was significantly explained by therapists who had experience practicing DMT but not CBT perceiving this combination as efficient. Second, the therapists' use of the combined therapy (DMT + CBT) approaches was not related to their sense of efficacy as therapists of children with ADs. The model represents concordance between the components of the therapists' attitudes: Affective—belief that it is efficient, cognitive—perception of it as effective, and behavioral—their actual use. [ABSTRACT FROM AUTHOR]

Although empathy is the one of the factors most strongly associated with good psychotherapy outcome, there is little research on how therapists become empathic. To better understand how empathy is developed, a critical-constructivist grounded theory analysis was conducted to examine novice therapists' process of learning to be empathic. In addition, this study explored the relationship between clinical and cultural empathy. Findings revealed that cultural empathy is experienced by contemporary trainees as an inherent and necessary aspect of clinical empathy. Therapists' clinical empathy served three crucial functions: (1) expanding their imaginative capacity so they could genuinely understand their clients, (2) sharing emotional experiences, which forges an sense of therapists' ethical obligation and promotes clients' trust, and (3) acting as a mechanism of change by directing clients' introspection strategically, leading to insight. Interviewees relayed that training broadened their capacity to engage these functions effectively across diverse clients and to overcome obstacles to accessing and expressing empathy effectively. Despite this, the students did not report receiving formal training related to empathy. The discussion considers the role of empathy training in terms of an ethics of care for diverse clients and recommends content to support the adequate and multidimensional training of this, this powerful common factor. [ABSTRACT FROM AUTHOR]

Background: Cognitive remediation (CR) therapy provides an effective way to improve cognitive impairments in schizophrenia. With the advent of telehealth services, especially during COVID 19 pandemic, a suitable alternative can be found in computer and cell phone-based mental health interventions. Previous studies have proven that remote mental health interventions have by and large been successful. Remote psychotherapy/CR services can now be accessed through smartphone apps, iPads, laptops and wearable devices. This has the advantage of reaching a wider population in resource-limited settings. The lack of access to technology, difficulty in using these online interventions and lack of privacy provide impediments to the delivery of care through these online platforms. Further, as some previous studies have shown, there may be a high rate of dropout in people using remote mental health resources. We aim to look at the factors, which influence the accessibility of remote mental health interventions in schizophrenia. Additionally, we test the feasibility of these interventions and look at how they compare and the potential they hold for implementation in future clinical settings. Results: We found remote cognitive remediation to be both accessible and feasible. Concerning features, however, are the high attrition rates and the concentration of the studies in Western populations. Conclusions: Remote interventions are a viable alternative to in-person psychotherapy when in-person resources may not always be present. They are efficacious in improving health outcomes among patients with schizophrenia. Further research into the widespread implementation of remote CR will be beneficial in informing clinical decision-making. [ABSTRACT FROM AUTHOR]

Purpose: Despite significant interest in improving behavioral health therapists' implementation of measurement-based care (MBC)—and widespread acknowledgment of the potential importance of organization-level determinants—little is known about the extent to which therapists' use of, and attitudes toward, MBC vary across and within provider organizations or the multilevel factors that predict this variation. Methods: Data were collected from 177 therapists delivering psychotherapy to youth in 21 specialty outpatient clinics in the USA. Primary outcomes were use of MBC for progress monitoring and treatment modification, measured by the nationally-normed Current Assessment of Practice Evaluation-Revised. Secondary outcomes were therapist attitudes towards MBC. Linear multilevel regression models tested the association of theory-informed clinic and therapist characteristics with these outcomes. Results: Use of MBC varied significantly across clinics, with means on progress monitoring ranging from values at the 25th to 93rd percentiles and means on treatment modification ranging from the 18th to 71st percentiles. At the clinic level, the most robust predictor of both outcomes was clinic climate for evidence-based practice implementation; at the therapist level, the most robust predictors were: attitudes regarding practicality, exposure to MBC in graduate training, and prior experience with MBC. Attitudes were most consistently related to clinic climate for evidence-based practice implementation, exposure to MBC in graduate training, and prior experience with MBC. Conclusions: There is important variation in therapists' attitudes toward and use of MBC across clinics. Implementation strategies that target clinic climate for evidence-based practice implementation, graduate training, and practicality may enhance MBC implementation in behavioral health. [ABSTRACT FROM AUTHOR]

Minor-attracted persons (MAPs; i.e., people who are sexually interested in children and adolescents below the age threshold of legal consent for sexual activity) exhibit high psychological distress but report difficulties finding therapeutic help and are reluctant to start treatment due to fears of therapist stigmatization. This research sought to elucidate the link between outpatient therapists' stigmatizing attitudes toward non-offending versus offending MAPs and therapists' willingness to treat MAPs as well as how stigmatization was related to treatment-relevant aspects such as perceived MAP treatment needs, treatment barriers, and specific MAP treatment skills. Results from a brief, anonymous online survey conducted among N = 427 Swiss outpatient therapists working in the primary healthcare system are reported. Although therapists were less stigmatizing than the general public, considerable individual differences in the stigmatization of non-offending MAPs emerged. Stigmatizing attitudes toward non-offending MAPs and a perceived lack of specific treatment competences were negatively related to therapists' willingness to treat MAPs. A network analysis revealed direct links between subjectively perceived MAP treatment competence and treatment willingness and between treatment willingness and social distance attitudes. Other stigmatizing attitudes were only indirectly linked to treatment willingness through preferred social distance. It is a paradox that therapists believe that MAPs should greatly benefit from secondary prevention but many are unwilling to provide therapy (45% in case of non-offending MAPs vs. 63% in case of offending MAPs) or do not feel competent to provide MAPs with professional help (47% with and 88% of therapists without previous MAP treatment experience). Implications for increasing therapists' treatment willingness are discussed. [ABSTRACT FROM AUTHOR]

With the new Psychotherapists Act a serious situation has arisen for psychoanalysis. One danger, technological medicalization (Buchholz 2017b, c; Buchholz and Kächele 2019), has often been referred to. A growing reliance on clinical psychology is still not very prominent (Slunecko 2021). How can psychoanalysis assert itself? It is proposed to devote more attention to questions of a) training of therapeutic personalities, b) stronger lifeworld contextualization, and c) paying much more attention to the original voice of patients in theory and case presentations. Loyalty to theory traditions does not solve any problems. It blocks sensitivity for social and other environments and produces withdrawal into self-preoccupation and a disturbing lack of irritability. The far too loyal attachment to theory traditions, to training analytical instructors and role models, supervisory practices and to questionable rules of treatment wards off the irritation, the overcoming of which would be a core task and discourages the next generation. Suggestions for this are given at the end. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine cross-cultural differences, as operationalized by Schwartz's refined theory of basic values, in burnout levels among psychotherapists from 12 European countries during the coronavirus disease (COVID-19) pandemic. We focused on the multilevel approach to investigate if individual- and country-aggregated level values could explain differences in burnout intensity after controlling for sociodemographic, work-related characteristics and COVID-19-related distress among participants. 2915 psychotherapists from 12 countries (Austria, Bulgaria, Cyprus, Finland, Great Britain, Serbia, Spain, Norway, Poland, Romania, Sweden, and Switzerland) participated in this study. The participants completed the Maslach Burnout Inventory-Human Service Survey, the revised version of the Portrait Values Questionnaire, and a survey questionnaire on sociodemographic, work-related factors and the COVID-19 related distress. In general, the lowest mean level of burnout was noted for Romania, whereas the highest mean burnout intensity was reported for Cyprus. Multilevel analysis revealed that burnout at the individual level was negatively related to self-transcendence and openness-to-change but positively related to self-enhancement and conservation values. However, no significant effects on any values were observed at the country level. Male sex, younger age, being single, and reporting higher COVID-19-related distress were significant burnout correlates. Burnout among psychotherapists may be a transcultural phenomenon, where individual differences among psychotherapists are likely to be more important than differences between the countries of their practice. This finding enriches the discussion on training in psychotherapy in an international context and draws attention to the neglected issue of mental health among psychotherapists in the context of their professional functioning. [ABSTRACT FROM AUTHOR]

COVID-19 is a frightening, stress-inducing, and unchartered territory for all. It is suggested that stress, loneliness, and the emotional toll of the pandemic will result in increased numbers of those who will seek psychological intervention, need support, and guidance on how to cope with a time period that none of us were prepared for. Psychologists, in general, are trained in and know how to help others. They are less effective in taking care of themselves, so that they can be their best in helping others. The article, which aims to heighten clinicians' awareness of the need for self-care, especially now in the post-pandemic era, describes the demanding nature of psychotherapy and the initial resistance by therapists to engage in self-care, and outlines the consequences of neglecting to care for themselves. We covered the demanding nature of psychotherapy and its grinding trajectory, the loneliness and isolation felt by clinicians in private practice, the professional hazards faced by those caring for others, and the creative and insightful ways that mental health practitioners can care for themselves for the good of their clients, their families, and obviously, themselves. [ABSTRACT FROM AUTHOR]

This article investigates distances between therapists and their clients in their experience of the therapeutic alliance across the duration of the psychotherapeutic treatments in a naturalistic study. We looked at the working alliances from different vantage points—rupture, repair of ruptures, distances in the alliance impressions of both clients and therapists—and their correlation with treatment outcome. The only predictive variable of alliance ruptures was the inability of therapists to bond sufficiently with their clients regarding a sustainable working atmosphere, which could be identified through a continuous distant alliance rating by the therapists. Alliance ruptures in turn significantly predicted premature termination of treatments, whereas alliance ruptures per se did not necessarily predict treatment outcome. The paper discusses the possible role of the quality of therapists' attachment styles as a potentially crucial variable in an effective working alliance in psychotherapy. [ABSTRACT FROM AUTHOR]

By helping individuals after traumatic experiences, the helper is also exposed to the consequences of trauma. The aim of this study was to determine the predictors of consequences of secondary exposure to trauma among clergymen and therapists (N = 140) helping victims of trauma in Poland. Symptoms of secondary traumatic stress (STS) were identified in 22.9% of the clergymen and 8.6% of therapists, and secondary posttraumatic growth (SPTG) in 61.4% of the clergymen and 42.9% of therapists. STS and SPTG predictors were identified based on regression models. In the case of clergymen, regret is a determinant of STS, and positive cognitive restructuring of SPTG. Research findings highlight the need to increase awareness of exposure to secondary trauma among the clergy, and for them to acquire greater skills for coping with stress. [ABSTRACT FROM AUTHOR]

With the growing prevalence of psychological interventions, it is vital to have measures which rate the effectiveness of psychological care to assist in training, supervision, and quality assurance of services. Traditionally, quality assessment is addressed by human raters who evaluate recorded sessions along specific dimensions, often codified through constructs relevant to the approach and domain. This is, however, a cost-prohibitive and time-consuming method that leads to poor feasibility and limited use in real-world settings. To facilitate this process, we have developed an automated competency rating tool able to process the raw recorded audio of a session, analyzing who spoke when, what they said, and how the health professional used language to provide therapy. Focusing on a use case of a specific type of psychotherapy called "motivational interviewing", our system gives comprehensive feedback to the therapist, including information about the dynamics of the session (e.g., therapist's vs. client's talking time), low-level psychological language descriptors (e.g., type of questions asked), as well as other high-level behavioral constructs (e.g., the extent to which the therapist understands the clients' perspective). We describe our platform and its performance using a dataset of more than 5000 recordings drawn from its deployment in a real-world clinical setting used to assist training of new therapists. Widespread use of automated psychotherapy rating tools may augment experts' capabilities by providing an avenue for more effective training and skill improvement, eventually leading to more positive clinical outcomes. [ABSTRACT FROM AUTHOR]

The objectives of this study were to investigate the naturalistic effectiveness of routine inpatient treatment for patients with obsessive–compulsive disorder (OCD) and to identify predictors of treatment outcome. A routinely collected data set of 1,596 OCD inpatients (M = 33.9 years, SD = 11.7; 60.4% female) having received evidence-based psychotherapy based on the cognitive–behavioral therapy (CBT) in five German psychotherapeutic clinics was analyzed. Effect sizes (Hedges' g) were calculated for several outcome variables to determine effectiveness. Predictor analyses were performed on a subsample (N = 514; M = 34.3 years, SD = 12.2; 60.3% female). For this purpose, the number of potential predictors was reduced using factor analysis, followed by multiple regression analysis to identify robust predictors. Effect sizes of various outcome variables could be classified as large (g = 1.34 of OCD–symptom change). Predictors of changes in OCD and depressive symptoms were symptom severity at admission and general psychopathological distress. In addition, patients with higher social support and more washing compulsions benefited more from treatment. Subgroup analyses showed a distinct predictor profile of changes in compulsions and obsessions. The results indicate that an evidence-based psychotherapy program for OCD can be effectively implemented in routine inpatient care. In addition to well-established predictors, social support, and washing compulsions in particular were identified as important positive predictors. Specific predictor profiles for changes in obsessions and compulsions are discussed. [ABSTRACT FROM AUTHOR]

The changes in thinking and working in the history of psychoanalysis are described as evolutions from the search for certain knowledge to a growing tolerance in dealing with the uncertainty inherent in psychoanalytic work. The corona pandemic as an external reality has created additional uncertainty. Its effects on clinical work and the setting are discussed. Another external reality, the new Psychotherapists Act, not only challenges the tradition of psychoanalytic training both in terms of organization and content but currently leaves both institutes and the professional society in uncertainty about their future. The implications and organizational risks of this situation for boards and members of training institutes are described. [ABSTRACT FROM AUTHOR]

A certain level of intimacy is necessary in psychotherapeutic relationships for them to be effective, but it can sometimes develop further into more intimate feelings and behaviors related to friendship and sexuality, into friendship, or even into sexual relationships. In this study, a self-administered questionnaire was sent to psychotherapists in Flanders (Belgium), asking about the occurrence of these situations. It provides an overview of these occurrences and comparative data to view for generational and cultural differences with previous studies. A response rate of 40% was obtained (N = 786): 69% of respondents were female therapists and none were transgender. A total of 758 therapists stated that they had actually provided psychotherapy and were included for further analysis. Three percent started a sexual relationship with a current and/or former client, 3.7% started a friendship during therapy, and 13.4% started a friendship after therapy. About seven out of ten therapists found a client sexually attractive, a quarter fantasized about a romantic relationship, and a fifth gave a goodbye hug at the end of a session (22%). In general, more male therapists reported sexual feelings and behaviors than female therapists. Older therapists more often behaved informally and started friendships with former clients compared to younger colleagues. Psychiatrists reported sexual feelings and fantasies less often than non-psychiatrists, and behavioral therapists reported this less frequently than person-centered and psychoanalytic therapists. Overall, prevalence rates of intimate feelings and behaviors related to friendship and sexuality are lower than those in previous studies. [ABSTRACT FROM AUTHOR]

Background: Functional Neurological Disorder (FND) is a complex neuropsychiatric condition with a multifactorial aetiology. The heterogeneity of patients with FND is rarely considered in psychotherapy trials, which may contribute to variable outcomes. Shared Individual Formulation Therapy (SIFT) is a new, brief (four session) psychotherapy that aims to accommodate heterogeneity by providing a personalised, trans-theoretical formulation of the person's difficulties and accompanying management plan. Methods: An open-label, prospective trial of outpatient SIFT for adults with FND was conducted, using health-related quality of life (SF-12) as the principal outcome measure, with secondary measures of mental health, dissociation, health care use and attitude to the FND diagnosis. Measures were collected at baseline, end of treatment and 6- and 12-month follow-ups. Results: Twenty-nine participants with various FND symptoms enrolled. Twenty-four completed all four sessions and 25 completed follow-up measures at 12 months. SF-12 scores improved significantly at end of treatment and were sustained throughout follow-up with moderate effect sizes (0.39–0.47; all p < 0.001). Most secondary outcomes also improved significantly at all time points. The intervention was highly acceptable and tolerable to patients and perceived as beneficial. Conclusion: This trial provides preliminary evidence for initial and sustained benefit from SIFT for adults with FND. Further study is needed to validate these findings. [ABSTRACT FROM AUTHOR]

The Open Dialogue approach was developed in Finland as a form of psychotherapy and a way to organize mental health systems. Open Dialogue has drawn global interest leading to adaptations worldwide, including in Vermont-US where it is called Collaborative Network Approach. Our study aimed to investigate the experiences of families who received Collaborative Network Approach in two agencies in Vermont. Qualitative interviews were conducted with 17 persons receiving services. Seven themes emerged: 1) network focus, 2) decision-making, 3) structure of care, 4) use of reflections, 5) medications, 6) hospitalizations, 7) challenges. Our study provides evidence that CNA is well-received, appreciated, and for many people an empowering form of mental health care. The findings suggest that elements of Open Dialogue are highly consistent with the vision for recovery-oriented care, in that they are flexible, person-centered, encourage processes of negotiation, and highlight the importance of family and social supports in care. [ABSTRACT FROM AUTHOR]

The unprecedented nature of the coronavirus pandemic and clinicians' own concerns for safety and stability amidst collective uncertainty have threatened to undermine our ability to trust what we already know about our clients and how to help them. Rather than search for a novel solution, I suggest that what we need during a shared crisis is to renew our trust in the existing ethos of good enough therapy, a metaphoric corollary to Winnicott's concept of good enough mothering, which presupposes the realities of imperfection and uncertainty along the continuum of growth. Using personal reflections, clinical vignettes from my psychotherapy practice, and drawing from modern attachment theory, contemporary relational psychoanalysis, and object relations theory, I posit in this article that clinical social workers already possess the framework, skills, and knowledge needed to deeply understand and meaningfully work with clients as they, and we, endure shared trauma. Through the clinical material, I examine opportunities to make use of clients' reactions, as well as my own, in order to deepen the therapeutic process. I discuss the necessity of holding the therapeutic frame with increased flexibility in light of my use of self-disclosure surrounding my COVID-19 diagnosis and recovery, and I assess the impact of this disclosure. [ABSTRACT FROM AUTHOR]

Healthcare increasingly emphasizes collaborative treatment by multidisciplinary teams. This is the first research focusing on psychologists' participation in team-based care, the mix of professionals with whom psychologists collaborate, and how these collaborations vary across practice settings. Data are from 1607 respondents participating in the American Psychological Association Center for Workforce Studies' 2015 on-line Survey of Psychology Health Service Providers. Practice settings differed markedly in systemic organizational support for interprofessional collaboration and in psychologists' participation in collaborative activities. Psychologists in individual private practice reported least support for and least occurrence of interprofessional collaboration. Psychologists' collaboration with non-behavioral health professionals, such as non-psychiatrist physicians and nurses, was more frequent in general hospitals and VA medical centers. Across settings, greater contact with another health profession was generally associated with psychologists being more confident about working with that profession. However, for work with psychiatrists, that association was attenuated. A collaborative practice model is presented for psychotherapy patients also treated by physicians or other professionals who manage a patient's psychotropic medication. [ABSTRACT FROM AUTHOR]

Background: Patient-reported outcomes (PROs) can be used to monitor patients during treatment. Healthcare provider preferences for individualized vs. standardized PROs have been understudied. Methods: This study surveyed oncology and mental health providers to compare attitudes towards individualized and standardized PROs. We have developed a method for individualizing PROs, called precision PROs, and the survey specifically assessed preferences for this method. We compared attitudes and preferences by provider type and by whether respondents were current or never users of PROs. Results: Oncology providers expressed more positive attitudes for standardized PROs in treatment planning compared to mental health providers (F(1,440) = 5.978, p = 0.015). The interaction between provider type (oncology vs. mental health) and type of PRO (individualized vs. standardized) was not significant for the attitudes about the clinical utility of PROs (p = 0.709). When directly asked about the precision PRO approach, oncologists were less likely to prefer standardized items (OR = 0.478, p = 0.001) or have no preference (OR = 0.445, p = 0.007) to the precision PRO approach when compared to mental health providers. Qualitative analyses suggested standardized PROs may be simpler or easier to understand whereas individualized PROs better capture patient variability and the unique aspects of each patient's condition. Some mental health providers expressed reticence about letting patients choose how to tailor PROs. Never users of PROs reported more positive attitudes towards individualized measures than standardized measures whereas current users of PROs did not have a difference in attitudes (p = 0.010). User status was mostly unrelated to preferences. Conclusion: Results suggest that healthcare provider preference for individualized PROs may differ by medical specialty. How PROs are tailored may need to differ by discipline. This is particularly important given that previous research showing a preference for individualized PROs over standardized was conducted with psychotherapists. Further research on patient preferences for individualized and standardized PROs is warranted as is research on the clinical utility of individualized PROs such as the precision PRO approach. [ABSTRACT FROM AUTHOR]

Background: On average, psychotherapy delivered on inpatient units produces clinical outcomes with smaller effect sizes than the same treatments in outpatient settings. The Collaborative Care CBT Milieu presents opportunities to extend the benefits of the therapeutic milieu by capitalizing on paraprofessionals who have the most interactions with patients. Methods: Mental health technicians (n = 27) were trained to use CBT strategies in daily interactions with patients on an adolescent inpatient unit. Communication about individualized CBT conceptualization and strategies were integrated into the functions of the unit across disciplines and shifts. Results: Compared to rates of use in the year prior to training, use of physical holds was reduced by 21.25% and use of mechanical restraints was reduced by 43.98%. Conclusions: The Collaborative Care CBT Milieu model demonstrates the feasibility of training MHTs to work in coordination with CBT therapists and other treatment team members to provide milieu interactions consistent with traditional CBT. Training staff to apply CBT theory and strategies within their scope of practice offers a pathway to an inpatient unit with a common language, shared lens for understanding patients, and unified approach to individualized care. Further research is needed to understand how these innovations impact clinical outcomes. [ABSTRACT FROM AUTHOR]

Common factors are nonspecific therapeutic elements common across different varieties of psychotherapy. In a recent study, 68 expert psychotherapy researchers with a variety of allegiances collectively rated biofeedback as being negatively associated with many common factors (Tschacher et al. in Clin Psychol Psychother 21(1):82–96, 2014), including the therapeutic alliance. However, it seems implausible that biofeedback could benefit so many people while being incompatible with the therapeutic alliance and other common factors. The present study investigated the experiences of biofeedback clients who participated in a brief heart rate variability biofeedback protocol in order to explore the potential roles of common factors in biofeedback. The results of this study offer preliminary evidence that many common factors—including therapeutic alliance, self-efficacy expectation, mastery experiences, provision of explanatory scheme, mindfulness, and even cognitive restructuring—may play a role in biofeedback outcomes. Future research on this topic should include mediation and moderation models investigating the role of specific common factors on outcome and process studies to help determine what clinician behaviors are most helpful. Deeper investigation of common factors in biofeedback may benefit future biofeedback research and practice and address the concerns of colleagues outside of the biofeedback community who believe that biofeedback is at odds with common factors. [ABSTRACT FROM AUTHOR]

Values are integral to psychotherapeutic work. Therapist and client values enter into the therapy room and interact in complex ways. There is increasing acknowledgement of the need for therapists to be aware of their personal and professional values. The present study focused on exploring the values held by Indian psychotherapists and their impact on psychotherapeutic practice. An exploratory qualitative study using a constructivist grounded theory approach was conducted with sixteen practising psychotherapists. Findings revealed that therapists' endorsed values of acceptance, autonomy and empowerment, honesty, humility, equality, respect, compassion, tolerance and openness to experience. The participants shared the influences or sources of their values, how they integrated personal and professional values, and the strategies they employed to handle value conflicts with clients. The role of culture and implications for reflective practice in therapist examining their values in psychotherapy training and supervision have been discussed. [ABSTRACT FROM AUTHOR]

The purpose of this study was to reconstruct the main ideas—universal but grounded in particular diagnostic experiences—used by psychotherapists during the case conceptualisation process. Authors focus on the process of diagnostic thinking expressed in graphic conceptual maps of a specific case. Two main questions were posed: (1) how do psychotherapists build patient understanding (a model of a patient)? (2) With what conceptual tools (categories, assumptions, ideas) do they think? The sample of fourteen conceptual maps from psychotherapists was used for the study presented here. The psychotherapists who were the authors of fourteen selected maps (years of experience: M = 21.38 years, SD = 13.53; 3 male, 11 female; age: M = 44.71; SD = 13.27) represented various approaches. A thematic analysis framework (Braun & Clarke, 2006) was used. Four major themes were identified across conceptual maps: (1) parental figures are depicted as pivotal; (2) basic assumptions about the "world order" are employed; (3) immersion in the patient's inner world (or internal phenomena); and (4) maintaining the tolerance of indefiniteness. Joining those themes together shows that assessment for psychotherapeutic purposes proves to be a generally dynamic, hypothetical and adjustable process, but also seems personally engaging and prone to using fixed categories, such as patient's parents and mental representations of them. Moreover, a psychotherapist's uncertainty seems not to inhibit the patient's understanding. This knowledge, based on generalized experience, can be particularly crucial for psychotherapists in monitoring their practice to direct their attention and reflection. [ABSTRACT FROM AUTHOR]

Pragmatic measures of therapist delivery of evidence-based practice (EBP) are critical to assessing the impact of large-scale, multiple EBP implementation efforts. As an initial step in the development of pragmatic measurement, the current study examined the concordance between therapist and observer ratings of items assessing delivery of EBP strategies considered essential for common child EBP targets. Possible EBP-, session-, and therapist-levels factors associated with concordance were also explored. Therapists and independent observers rated the extensiveness of therapist (n = 103) EBP strategy delivery in 680 community psychotherapy sessions in which six EBPs were used. Concordance between therapist- and observer-report of the extensiveness of therapist EBP strategy use was at least fair (ICC ≥.40) for approximately half of the items. Greater therapist-observer concordance was observed in sessions where a structured EBP was delivered and in sessions where therapists reported being able to carry out planned activities. Findings highlighted conditions that may improve or hinder therapists' ability to report on their own EBP strategy delivery in a way that is consistent with independent observers. These results can help inform the development of pragmatic therapist-report measures of EBP strategy delivery and implementation efforts more broadly. [ABSTRACT FROM AUTHOR]

Terminating a therapeutic relationship can be a challenging phase with patients suffering from borderline personality disorder. Despite the critical importance of the termination phase, the proportion of psychotherapy literature devoted to the demands and challenges of this phase is small. This paper describes a mentalization-based approach to detect and intervene against such challenges. It is proposed that termination challenges, while operating through overlapping and interactive mechanisms, can be attributed to (1) patient factors, (2) therapist factors, and (3) therapeutic relationship factors. The paper has clinical implications and suggests that the aim of enhancing mentalizing capacities should include mentalizing the often complicated and mixed feelings associated with separation and loss of the therapeutic relationship. To facilitate this process, we propose the use of a "termination formulation", in which patients' outcomes and future goals are recapitulated in the termination phase of mentalization-based therapy. [ABSTRACT FROM AUTHOR]

Children with Down syndrome (DS) have deficits in eye-hand coordination skills. Deficits in eye-hand coordination could negatively impact the acquisition of literacy skills. This paper presents the evaluation of BeeSmart, a gesture-based videogame for supporting eye-hand coordination and pre-literacy skills. The aim of this work is to investigate whether BeeSmart has the potential to support eye-hand coordination and pre-literacy skills of children with DS. A 10-week study with seven children with DS and two psychotherapists is presented. The results indicate that BeeSmart was perceived as a potential tool to support eye-hand coordination and pre-literacy skills. Three out of seven participants improved their eye-hand coordination and pre-literacy skills to some degree. The evaluation study also revealed some improvements that should be made to BeeSmart, such as a reward counter for children with DS with a higher cognitive level. More game sessions with BeeSmart is required to investigate at what degree of BeeSmart improves eye-hand coordination and pre-literacy skills of children with DS. [ABSTRACT FROM AUTHOR]

The article presents the results of a thematic analysis of statements about polyamory made in the media by Polish psychology and sexology experts. The analysis was conducted on the basis of 20 pieces of material released in the Polish national press, radio, and television between July 2012 and October 2018. The results show that most of the analyzed experts approach polyamory with suspicion. In most cases, the decision to be in a polyamorous relationship is assessed very negatively, and in the eyes of the therapists it is evidence of psychological defects in people who make such attempts or it is seen as a harbinger of unfavorable outcomes for the relationship. This negative psychological evaluation is often accompanied by a strong moral assessment and a clear willingness to discourage society from this relationship model. The results show that representatives of psychology and medical sciences in the Polish media support and legitimize the social and moral order that promotes mono-normativity. The true reasons for the aforementioned negative assessment are hidden behind a veil of scientific objectivity. [ABSTRACT FROM AUTHOR]

The objective of this article is to review how primary care providers – paediatricians, family practitioners, nurse practitioners - could address the use of substances by adolescents and respond to problematic behaviours and situations. Given the highly addictive properties of nicotine, adolescents should be supported in avoiding any consumption of tobacco or quitting if they already do so. Screening and investigation of substance use is usually not difficult, provided that it is processed in a neutral and empathetic atmosphere and securing confidentiality if the adolescent asks for it. Any type of substance use is potentially linked with adverse events such as injuries, violence, unplanned and unsafe sexual experience, alcoholic coma, 'bad trips' or unpleasant psychological experiences. As such, substance use should be identified and openly discussed with the adolescent. Moderate intermittent recreational use of legal and illegal substances (mainly alcohol and cannabis) should be carefully monitored over time, as it can lead to problematic use. Problematic use and substance use disorder require various interventions, including motivational interviewing, family counselling and psychotherapy, especially when substance use is linked with mental health disorders. Despite the importance of confidential care, parents or caregivers should be involved in problematic situations as much as possible. What is known: • While problematic use of substances is transient amongst many adolescents, it may be a threat to health and school/professional functioning • Primary care providers (PCPs) can address queries or offer preventive interventions to adolescents who use substances What is new: • Some interview tools can assist PCPs efficiently to identify problematic users of substances • There are effective approaches that PCPs can use to address problematic use by adolescent patients [ABSTRACT FROM AUTHOR]