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Background: The process of identifying and discontinuing medicines in instances in which harms outweigh benefits (deprescribing) can mitigate the negative consequences of problematic polypharmacy. This process should be conducted with a focus on the patient and involve collaborative decision-making. Evidence is needed regarding patients' views on how deprescribing should be safely and routinely implemented in English primary care to improve its application. This study aimed to identify optimal methods of introducing and actioning deprescribing from the patient's perspective. Methods: Participants in England aged 65 and above who were taking five or more medicines and residing in their own homes were recruited through social media and service user groups. An interview guide was created from deprescribing literature and input from patients and the public, guided by the Normalisation Process Theory (NPT). The interviews were held online using Microsoft Teams® or via phone, recorded, and then transcribed. The data was analysed using the Framework analysis. Results: Twenty patients (mean age of 74.5, SD = 6.93), with 75% being female, were enrolled in the study. Three main themes emerged: (1) 'Why deprescribe now?' emphasised the significance of explaining the reasons behind deprescribing; (2) 'Monitoring and follow-up' underscored the necessity of safety measures during deprescribing and patients' willingness to self-monitor post-intervention; (3) 'Roles and relationships' explored patient perceptions of various healthcare professionals involved in deprescribing and the essential interpersonal skills for fostering therapeutic relationships. Conclusion: Optimal methods of introducing deprescribing included communicating a convincing rationale for stopping medicines and preparing patients for deprescribing conversations. Patients required support from a range of healthcare professionals with whom they had an existing therapeutic relationship. Whilst patients were motivated to self-monitor unwanted/unexpected effects post-deprescribing, timely support was required. The nature of such bolstered collective action and cognitive participation within NPT enhances the normalisation potential of deprescribing. These findings highlight the significance of considering the content and process of deprescribing consultations to enhance normalisation and tackle problematic polypharmacy. This provides a deeper understanding of patients' needs for implementing safe and routine deprescribing in primary care, which should be considered when designing medication review and deprescribing services. [ABSTRACT FROM AUTHOR]

Objective: In this naturalistic study we aimed to investigate the relationships between two central change processes (affective and cognitive) and two common relationship factors ("Confidence in the therapist" and "Confidence in the treatment"), which have been shown to impact outcomes in a clinical context. We also investigated whether these interrelationships varied across treatment orientations (i.e., cognitive or psychodynamic focused). Method: The sample consisted of 631 patients with a primary anxiety or depressive disorder who were admitted to an inpatient program and treated with psychotherapy. The data consisted of weekly measures of cognitive (i.e., "rumination") and affective (i.e., "problems with emotional clarity") change processes as well as scores on Confidence in the therapist and Confidence in the treatment and symptom distress. A multivariate version of the latent curve model with structured residuals was used to investigate the within-patient effects of week-to-week changes in all variables. Results: Initial analyses established that both problems with emotional clarity and rumination predicted symptom distress. Further, we found that higher Confidence in the therapist predicted higher emotional clarity (but not lower rumination) whereas higher Confidence in the treatment predicted lower rumination (but did not affect emotional clarity). Post hoc analyses found that these interrelationships varied across treatment orientation (i.e., cognitive vs. psychodynamic). Discussion: The results indicate that patients' experience of the therapist is associated with emotional change processes, and that patients' experience of the coherence and meaningfulness of treatment, on the other hand, is associated with cognitive change processes. Implications for clinical practice are discussed. What is the public health significance of this article?: This study suggests that emotional and cognitive change processes are associated with different aspects of the therapeutic relationship. Specifically, emotional change seems to be associated with patients' experience of the personal relationship with their therapist, while cognitive change seems to be associated with patients' experience of the treatment as a meaningful remedy for their problems. Different treatment orientations (i.e., psychodynamic and cognitive focused) seem to activate different pathways of change through the therapeutic relationship. [ABSTRACT FROM AUTHOR]

All contemporary psychotherapies agree that (failing) emotion regulation is central to psychological disorders and that psychotherapy is about improving emotion regulation. In his research on the "emotion‐laden" complex Jung put an emphasis on the role of failing emotion regulation in contributing to psychological disorders as well as to change in the process of psychotherapy, but he left this field of research and took a very different direction in favour of his archetype concept. Psychodynamic approaches generally argue that changes in emotion regulation are accomplished through corrective emotional experiences in the therapeutic relationship. Insights from affective neurosciences and attachment research have had a major influence on how the therapeutic relationship is constructed in contemporary psychodynamic approaches. There is a lack of similar developments in analytical psychology, which leads to substantial differences between the models of Jungian psychotherapy in contrast to other contemporary psychodynamic approaches. The implications of these differences for the practice of psychotherapy and especially the role of the therapeutic relationship are pointed out. [ABSTRACT FROM AUTHOR]

Our objective is to implement a single-case experimental design (SCED) infrastructure in combination with experience-sampling methods (ESM) into the standard diagnostic procedure of a German outpatient research and training clinic. Building on the idea of routine outcome monitoring, the SCED infrastructure introduces intensive longitudinal data collection, individual effectiveness measures, and the opportunity for systematic manipulation to push personalization efforts further. It aims to empower psychotherapists and patients to evaluate their own treatment (idiographic perspective) and to enable researchers to analyze open questions of personalized psychotherapy (nomothetic perspective). Organized around the principles of agile research, we plan to develop, implement, and evaluate the SCED infrastructure in six successive studies with continuous stakeholder involvement: In the project development phase, the business model for the SCED infrastructure is developed that describes its vision in consideration of the context (Study 1). Also, the infrastructure's prototype is specified, encompassing the SCED procedure, ESM protocol, and ESM survey (Study 2 and 3). During the optimization phase, feasibility and acceptability are tested and the infrastructure is adapted accordingly (Study 4). The evaluation phase includes a pilot implementation study to assess implementation outcomes (Study 5), followed by actual implementation using a within-institution A-B design (Study 6). The sustainability phase involves continuous monitoring and improvement. We discuss to what extent the generated data could be used to address current questions of personalized psychotherapy research. Anticipated barriers and limitations during the implementation processes are outlined. [ABSTRACT FROM AUTHOR]

In this study, we examined how four components of the therapeutic relationship—working alliance, real relationship, and positive and negative affective reactions of the patient toward their therapist—relate to each other and to the psychotherapy session outcome, from the patient’s point of view. Our simple comprised 700 adult patients in individual psychotherapy who were recruited and participated online. They underwent a baseline evaluation of their most recent therapy session, which encompassed a series of validated self-report measures focused on specific elements of the therapeutic relationship. The results revealed that, from the patient’s perspective, working alliance, real relationship, and positive affective reactions toward the therapist were positively correlated with session outcome, while negative affective reactions were negatively correlated. All components predicted session outcome when simultaneously included in a regression model. Collectively, these four components accounted for 30% of the variance in session outcome. Factor analysis revealed four distinct factors, underlying perceptions of the therapeutic relationship. Notably, the bond dimension of the alliance was sufficiently different from the task and goal dimensions, warranting consideration as a distinct construct. These findings, although cross-sectional, lay the groundwork for a more nuanced investigation of multiple dimensions of the therapeutic relationship. [ABSTRACT FROM AUTHOR]

Recent studies show that, when salience is high, 'heterogeneous lobbying coalitions' uniting business and civil society groups are more successful in achieving their lobbying objectives than homogeneous coalitions. It is therefore surprising that a coalition of tech firms and civil society activists failed to prevent the adoption of the EU's contested 2019 Copyright Directive, which constitutes a significant shift in the Union's approach to online content regulation. This article argues that proponents of the policy change successfully undermined the lobbying coalition by invoking notions of 'digital sovereignty' and by delegitimizing activists as Silicon Valley's 'useful idiots'. Combining process-tracing of the lobbying processes and content analysis of European Parliament debates, the article shows how legislators employed delegitimation and sovereignty claims to justify their non-responsiveness to public protests. The article contributes to the interest group literature and debates on 'digital sovereignty' by demonstrating its strategic use in the policy-making process. [ABSTRACT FROM AUTHOR]

Background: The therapeutic alliance (TA) is a robust and pantheoretical predictor of treatment outcome in Face-to-Face-(F2F-) and Online-psychotherapy (Online-PT). Many authors have proposed several conceptualizations of TA, which are oftentimes operationalized. The resulting diversity of conceptualizations and measures is presented in this review. Methods: We performed a three-parted literature search for self-reportinstruments of TA in individual, voluntary F2F-PT with adults (1. utilization of past reviews, 2. systematic literature search yielding 5,205 articles, 3. reference lists). Analogously, we conducted a systematic literature search for instruments of TA in the Online-setting (yielding 200 articles). Additionally, we analyzed the content of the instruments qualitatively. Results: A current overview of 48 instruments for measuring TA (46 for F2F-PT, 2 for Online-PT) including their conceptual backgrounds, characteristics and main content aspects is presented. Most instruments (n = 24) operationalize one or more theoretical conceptualizations of TA. Other instruments are adaptation/syntheses of existing measures (n = 14), based on literature searches (n = 3) or on an empirical survey (n = 3) and two instruments provide no conceptual background information. The content of the instruments mainly focused on the following aspects: 1. Self-disclosure and authenticity; 2. Agreement; 3. Active participation, motivation and compliance; 4. Trust and secure attachment; and 5. Considering needs/abilities/wishes of the patient. Additionally, a narrative review of various approaches to conceptualize TA is presented and linked to respective corresponding instruments. Discussion: The broad variety of conceptualizations and measures of TA makes coherent research on TA difficult. There are conceptual challenges such as the role of attachment style in TA that remain to be clarified. The current conceptualizations and measures do not incorporate the practical experience and expertise of psychotherapists and patients sufficiently. A metatheoretical conceptualization and measure of TA based on an empirical survey of psychotherapists and patients could address these issues. [ABSTRACT FROM AUTHOR]

This article discusses the current state of psychedelic research and its implications. It highlights the growth of clinical research on psychedelic compounds for various psychiatric and medical conditions, as well as the training of therapists to facilitate psychedelic sessions. The article also mentions efforts to legalize or decriminalize psychedelics and the increase in commercial and financial interests in the field. It emphasizes the need for larger studies, ethical standards, and public education to navigate the complex landscape of psychedelic research. The article also reflects on the historical contributions of pioneers in the field and their relevance today. Overall, it presents a balanced perspective on the potential therapeutic breakthroughs and the importance of responsible approaches to psychedelic research. [Extracted from the article]

The emotional responses of psychotherapists to their patients, known as countertransference, can yield valuable insights into the patient's psychological functioning. Albeit from a different perspective, the Rorschach test also provides information about the patient's psychological processes. In particular, the Rorschach human movement response (M) has been shown to be a useful measure of higher-level psychological functioning. In an attempt to bridge these two largely different perspectives, the aim of this study was to explore the association between M responses in the Rorschach protocols of psychotherapy patients and emotional responses exhibited by their therapists. To this end, a convenience sample of 149 outpatients were administered the Rorschach according to the Comprehensive System, and their therapists completed the Therapist Response Questionnaire. Through a series of regression models, controlling for response style, response complexity, and degree of psychopathology, M demonstrated a significant association with the therapists' emotional responses. A lower number of M responses was associated with the therapists' feelings of disengagement, and a higher number of M responses was associated with the therapists' feelings of being more involved with the patient. Taken together, these results suggest a potential relationship between the number of M responses the respondent gives in the Rorschach and the subsequent development of the therapeutic alliance between the respondent and their therapist. [ABSTRACT FROM AUTHOR]

Aim. The emotional reactions of the therapist in the treatment process constitute the core of therapeutic work, but they are poorly represented in research area. The article presents the results of work on the creation of a new tool - Questionnaire for the Perception of Psycho-therapy Process by the Psychotherapist (QPPP). Method. The Questionnaire containing 267 statements assessing cognitive, affective and behavioral reactions of psychotherapists in interaction with a specific patient was uploaded on the website. The link to the website, together with a request to complete the questionnaire, was sent to the members of the Psychotherapeutic Societies. The study involved 159 therapists, working mainly psychodynamically (91.95%). The analysis of basic descriptive statistics of test items and exploratory factor analysis by principal components method with varimax rotation were used. Results. The work resulted in creating a tool consisting of 75 items grouped into 6 scales: "Positive cooperation with the patient", "Therapist burdened with commitment", "Therapist in the centre of negative interest", "Therapist with no room for intervention", "The overwhelmed/ overloaded therapist", "The helpless/disengaged therapist". High Cronbach's alpha reliability of all distinguished factors was demonstrated at the level from 0.79 to 0.94. The data analysis also made it possible to create initial sten standards for therapists working in the psychodynamic approach. Conclusions. A tool was developed to assess emotions of the therapist in relation to the client. The QPPP contains generally understandable terminology, independent of the therapist's dominant modality. The questionnaire can have many practical, both scientific and clinical, applications. [ABSTRACT FROM AUTHOR]

Therapy for personality disorder can be understood as a process of enhancing attachment security. This study tests the theory that individuals in a secure forensic mental health setting with a diagnosis of personality disorder who have undertaken psychological therapy will report secure patterns of attachment in their relationship with their therapist. It uses a novel pattern matching approach that assesses the behavioural, cognitive and affective markers of attachment security in a group of patients undergoing therapy. Eight behavioural, cognitive and affective characteristics of secure attachment were identified. Ten patients completed a semi-structured interview about their experiences in therapy and key relationships, and their responses were reviewed for evidence of these eight characteristics. Nine out of ten participants were judged to have demonstrated a pattern of six or more of the eight characteristics of secure attachment. This study supports the theory that treatment for this group of patients works by developing patient-therapist attachments. A focus on attachment issues should, therefore, be a core aspect of therapy. [ABSTRACT FROM AUTHOR]

Objective To investigate clients' perceptions of changes in their therapists' provision of positive regard (PR) following their transition from in-person therapy to teletherapy. Method A total of 2,118 clients, predominantly White, female, heterosexual, and in their mid-20s, who had been working with their therapist for an average of 20 months in-person and five months in teletherapy completed a Perceptions of Psychotherapy Process Scale (POPPS). This 42-item measure investigated, at a single time-point, the extent to which participants believed that specific therapist-related behaviors, statements, or attitudes changed since shifting to teletherapy. Results An exploratory factor analysis revealed, among other factors, a factor comprised of six items related to therapist-provided PR (e.g., "my therapist makes me feel cared about"). Clients' scores on this factor indicated a marginal but significant increase in therapists' provision of PR over teletherapy; these scores also significantly predicted scores on a factor reflecting clients' engagement in teletherapy. Conclusions Despite the challenges of an abrupt shift to teletherapy, clients perceive their therapists as communicating PR to the same or even slightly higher degrees as compared to in-person therapy pre-pandemic; therapists and clients have seemingly adapted to the new demands of technology to preserve important elements of the therapeutic relationship. [ABSTRACT FROM AUTHOR]

The current demographic change means that young psychotherapists and older patients will increasingly come into contact. Unique for this constellation is the intergenerational therapeutic relationship, which forms the basis of psychotherapy, but has not yet been the focus of empirical research. This qualitative study provides preliminary insights into how older patients (aged over 65) experience and perceive the therapeutic relationship with young psychotherapists (aged in their mid-20s to mid-30s). We conducted semi-structured interviews with twelve older patients (8 women, 4 men) and analysed their data using the grounded theory approach. We found a connection between the type of transference a participant demonstrated and their biographical as well as social experiences, desires, and fantasies. Overall, a tendency to seek harmony was observed among the participants, which was reflected in their behaviour towards young psychotherapists: (a) conflict avoidance, (b) (fantasised) therapy discontinuation, (c) adaption/subordination, and (d) solidarity, support, and protection. Our findings demonstrated that various intergenerational transference phenomena, including the roles in which young therapists are perceived, are associated with certain particularities and challenges, such as the topic of sexuality. It can be valuable for young psychotherapists to become aware of a potential role reversal that may result in older patients trying to support them. [ABSTRACT FROM AUTHOR]

Background: Working alliance is a prominent non-specific factor for treatment outcomes in face-to-face and internet-based interventions. The association between working alliance and therapy outcome appears to be time- and disorder-specific, but less is known about the change of working alliance during the intervention and the impact of working alliance in grief-specific interventions. The present study examines the association between the change of working alliance and treatment outcomes in an internet-based intervention for parents who experienced pregnancy loss. Methods: 228 participants received a grief intervention based on cognitive behavioral therapy with asynchronous text-based therapist feedback. Prolonged grief and related symptoms of traumatic stress, depression, anxiety, and general psychopathology were assessed with validated instruments before and after the intervention. The change of working alliance was assessed using the short version of the Working Alliance Inventory at mid-treatment (session 4) and the end of the treatment (session 10). Results: Data for N = 146 persons was analyzed. Working alliance in total and all subscales increased significantly from sessions 4 to 10. This change in working alliance correlated significantly with a reduction in prolonged grief. Changes in subscales of working alliance also correlated with symptoms of depression and general psychopathology. Regression analysis showed that a change in working alliance predicted a reduction in prolonged grief but did not predict improvements in other grief-related symptoms. Conclusion: The results examine the change of working alliance during an internet-based intervention and the association with treatment outcome. A small impact of change in working alliance on treatment outcome of prolonged grief was confirmed, but not on related symptoms. Further research is needed to assess moderators of the alliance-outcome association to improve internet-based interventions. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

"The Psychotherapist and the Professional Complaint: The Shadow Side of Therapy" is an edited collection of essays that provides critical perspectives on professional complaint processes in psychotherapy. The book explores the experiences of therapists who have received patient complaints, highlighting the emotional impact and potential harm to their professional reputations. It argues for the need to reform the current legalistic and adversarial processes for handling complaints, suggesting restorative justice and the alignment of professional bodies' complaints processes under a single disciplinary center. However, the book's focus on therapists as victims of false complaints raises ethical challenges and neglects the potential for therapists' own aggression and narcissism. It also lacks a thorough examination of social power structures and their impact on patients' ability to make valid complaints. Overall, the book emphasizes the need for a deeper exploration of the shadow side of the psychotherapy profession and ongoing issues related to social power structures. [Extracted from the article]

Attorney-client privilege was held by the Supreme Court to extend beyond death in 1996, albeit only ratifying centuries of accepted practice in the lower courts and England before them. But with the lawyer's client dead, the natural outcome of such a rule is that privilege--the legal enforcement of secrecy--will persist forever, for only the dead client could ever have waived and thus end it. Perpetuity is not traditionally favored by the law for good reason, and yet a long and broad line of precedent endorses its application to privilege. The recent emergence of a novel species of privilege for psychotherapy, however, affords an opportunity to take a fresh look at the long-tolerated enigma of eternity and the imprudence of thoughtlessly importing it to the newest addition to the family of privileges. Frankly, humanity has always deserved better than legalisms arrogating to the inscrutability of the infinite. [ABSTRACT FROM AUTHOR]

The September edition of the Journal of Analytical Psychology explores various topics through the lens of analytic psychology. The articles delve into Jung's views on psychedelics, collective polarizations, and the threat of self-annihilation. One paper examines Jung's skepticism towards psychedelics and his correspondence with Bill Wilson, the founder of Alcoholics Anonymous. Another paper explores the alchemical understanding of the analytic relationship and its impact on therapeutic transformation. Additionally, there are discussions on emotion regulation, the public understanding of analytical psychology, and an interview with Jan Wiener. The journal also includes clinical commentaries, journal reviews, and an invitation for readers to contribute their own papers. [Extracted from the article]

The aim of the study: To assess how the therapeutic relationship is perceived by therapists both in online and face-to-face therapy during the Covid-19 pandemic and if the therapist's personal, professional, and psychological characteristics, as well as their experience of the COVID-19 pandemic influence their perception of the therapeutic relationship. Material and Methods: Recruited 327 psychotherapists from four European countries: Sweden (Northern Europe), Poland (Eastern Europe), Portugal (Southern Europe) and Germany (Central Europe). Used original questionnaire and the Scale to Assess Therapeutic Relationship (STAR), the Fear of Contracting COVID-19 Scale (FCS Covid-19), the Pandemic Fatigue Scale (PFS), the Hospital Anxiety and Depression Scale (HADS), the Social Support Questionnaire (F-SozU K-14) and the Sense of Efficacy Test (SET). Results: The therapeutic relationship is perceived as more effective and productive in face-to-face therapy, although therapists noticed more emotional difficulties in this form than in online therapy. The predictor of the assessment of the overall quality and strength of the therapeutic relationship in online therapy is the therapist's self-efficacy, whereas in face-to-face therapy are the therapist's depression, age and cognitive / behavioral approach. Discussion: Variables related with therapist's personal, occupational, psychological characteristics, and their experience with COVID-19 pandemic are related to the perception of the therapeutic relationship and these relationships, although in different configurations, apply to both online and face-to-face therapy. Conclusions: The obtained results broaden the scope of knowledge about the therapeutic relationship, and also encouraged therapists to reflect on the factors that are important for its assessment. [ABSTRACT FROM AUTHOR]

This paper articulates the positive effects on the therapeutic relationship between an adult with neurodiversity, their family, and their counselor of a counseling career growth opportunity in expressive arts play therapy. In a larger sense, this articulation exemplifies the importance of career growth opportunities for mitigating counselor burnout by strengthening a counselor's ability to form deeper therapeutic relationships with their clients. [ABSTRACT FROM AUTHOR]

Psychoanalytic theory and practice consider both transference and countertransference as cornerstones for understanding those complicated psychological phenomena which psychoanalysis and psychoanalytic psychotherapy bring to light. The relationship between a patient and a psychoanalyst has been the crucial point on which our attention and interest is focused. In the intersubjective space of psychoanalytic psychotherapy, all interactions between the patient and the analyst are considered to mutually influence each participant of the analytic dyad. Together with patients, clinicians get involved in ambiguous, uncanny and unavoidable enactments. The understanding of the latter requires from a psychoanalyst not only to contain the patient's anxiety and reflect on the patient's inner feelings but also to stay open to the gamut of feelings, anxieties and conflicts that arise from the professional's experience. I suggest that accomplishing the complicated task of understanding both the patient's and his own feelings and experience leads the analyst to the necessity of restoring links with himself. By means of clinical material, I make an attempt to show how the process of understanding an uncanny enactment becomes for the therapist a process of restoring the links in countertransference which, in turn, enables the therapist to interpret the patient's specific difficulties. [ABSTRACT FROM AUTHOR]

"The Analyst's Vulnerability: Impact on Theory and Practice" by Karen J. Maroda is a book that presents the author's vision of psychoanalysis, specifically relational psychoanalysis, which emphasizes the importance of the analyst's vulnerability and personal experiences in the therapeutic process. The book explores the limitations of traditional psychoanalytic approaches, such as neutrality and anonymity, and argues for a more humanistic and interactive approach to therapy. While the author's perspective may not resonate with everyone, the book offers valuable insights and prompts readers to reflect on the role of the analyst in the therapeutic relationship. [Extracted from the article]

The article discusses the importance of personalizing psychotherapy treatment for both patients and therapists. Traditionally, efforts have focused on personalizing interventions to the patient, but recent advancements in technology and statistical analysis have allowed for the development of predictive algorithms that can determine which treatment packages or interventions are most effective for individual patients. The article suggests that treatment decisions should also be personalized to the therapist, using their own practice-based evidence to match them with patients they are most equipped to help. A randomized controlled trial found that intentional matching of patients to therapists' strengths resulted in greater symptom reduction and functional improvement. The article concludes by discussing future directions for research, including matching patients to therapists' measurement-based strengths based on race/ethnicity or other factors, and identifying therapist-level predictors of effective therapy processes. Overall, the article emphasizes the importance of personalized care in improving mental health outcomes and reducing disparities. [Extracted from the article]

Introduction and purpose: The main aim of our study is to summarise existing knowledge and draw conclusions about the impact of magnesium deficiency on the occurrence of anxiety. Methodology: The literature available in the National Library of Medicine database at https://pubmed.ncbi.nlm.nih.gov and Google Scholar was reviewed. Articles were searched by using keywords: magnesium, deficiency, supplementation, anxiety disorders. Forty-seven research papers and meta-analyses were analysed. Description of the state of knowledge: Magnesium is an extremely important mineral in the human body involved in many physiological processes. A deficiency of this element affects the whole body and can cause mental disorders - including anxiety disorders. There are many theories showing a link between magnesium and anxiety disorders in both humans and animals. Magnesium has been shown to influence the function of neurotransmitters affecting the experience of anxiety. Supplementation in people with hypomagnesaemia has been proven to improve their health and well-being. However, it should be noted that supplements on the market vary in the bioavailability of the mineral, and the frequency of intake and dosage also affect the bioavailability of magnesium. Conclusions: It is important to ensure adequate levels of magnesium in the diet, given its impact on the proper functioning of the human body (including the nervous system) and the fact that most people consume insufficient amounts of this macronutrient. Evidence of a link between magnesium levels and anxiety has led to increased interest in the potential efficacy of magnesium supplementation to alleviate anxiety symptoms. [ABSTRACT FROM AUTHOR]

ChatGPT is a chatbot based on a large language model. Its application possibilities are extensive, and it is freely accessible to all people, including psychotherapists and individuals with mental illnesses. Some blog posts about the possible use of ChatGPT as a psychotherapist or as a supplement to psychotherapy already exist. Based on three detailed chats, the author analyzed the chatbot's responses to psychotherapists seeking assistance, to patients looking for support between psychotherapy sessions, during their psychotherapists' vacations, and to people suffering from mental illnesses who are not yet in psychotherapy. The results suggest that ChatGPT offers an interesting complement to psychotherapy and an easily accessible, good (and currently free) place to go for people with mental-health problems who have not yet sought professional help and have no psychotherapeutic experience. The information is, however, one-sided, and in any future regulation of AI it must also be made clear that the proposals are not only insufficient as a psychotherapy substitute, but also have a bias that favors certain methods while not even mentioning other approaches that may be more helpful for some people. [ABSTRACT FROM AUTHOR]

Epistemic trust can be defined as the ability to rely on social and cultural information from others. It allows to integrate the new knowledge in the vision of self and world, promoting the learning from experience. Recently, the issue of epistemic trust is gaining growing interest in literature thanks to the recognition of the significant implications that it may have for treatment effectiveness but not only, as evidenced by the extension of it field of research and application to different contexts and psychopathological conditions. However, this makes it increasingly difficult to identify a unique relational dynamic between epistemic trust, attachment and mentalization. In addition, this issue is still predominantly addressed on the theoretical level, while empirical studies are still scarce, and this allows each researcher to make a different hypothesis. Therefore, this systematic review aims at exploring the role of epistemic trust in the relationship between attachment and mentalization, looking also at factors able to affect this bond. The keywords were the following: “mentalization”, “attachment” and “epistemic trust” and its dimensions and dysfunction. Articles were included if they explicitly focused on the relationship between attachment, mentalization and epistemic trust, and if they were research articles. Studies were excluded if they addressed only one or two of the three constructs, and if they were theoretical articles, opinion articles, commentary, book chapters and interviews. Results predominantly showed a relation of interdependence between these variables, although from studies that empirically investigated this topic an interesting, contrasting datum emerges: there seems to be a relationship of interdependence only between mentalization and epistemic mistrust or credulity, but not between mentalization and epistemic trust. These findings highlight the need to empirically deepen the link between these three variables and suggest therapists to pay attention not only to the creation of a secure therapeutic relationship and the improvement of mentalizing abilities, but also to clients’ epistemic trust, especially to its disrupted forms. [ABSTRACT FROM AUTHOR]

The success of higher education institutions is often measured by their competitiveness and the quality of their graduates in the job market. The concept of competitiveness, particularly in terms of educational relevance, is a fundamental consideration outlined in Law No. 12 related to higher education. One of the mechanisms for assessing this educational relevance involves conducting tracer studies among graduates. The objective of this research is to examine the individual (partial) and combined (simultaneous) effects of Grade Point Average (GPA) and Academic Supporting Credit for Students (AKPAM) on the alignment between graduates' fields of study and their subsequent employment. This study focuses on alumni from Darussalam Gontor University in the year 2019. The research is conducted through a survey-based approach, and the data collected through tracer study questionnaires. The findings indicate that while GPA exhibits an insignificant influence on the degree of alignment between fields of study and employment, AKPAM significantly affects this alignment. Moreover, when considered together, both GPA and AKPAM exert a significant influence on the alignment between graduates' fields of study and their employment choices. [ABSTRACT FROM AUTHOR]

The book "Navigating the Realities of Metaphor and Psychotherapy Research" by Dennis Tay explores the collaborative research between metaphor researchers and psychotherapists. The book focuses on the use of metaphor in psychotherapy and its impact on therapeutic outcomes. It discusses the importance of collaboration between linguistically-trained metaphor researchers and therapists, and provides practical insights and methodologies for conducting collaborative research. The book also explores the potential applications of collaborative research in other domains, such as language education and advertising. Overall, it offers a valuable resource for researchers, practitioners, and beginners interested in collaborative research and the role of metaphor in psychotherapy. [Extracted from the article]

Exploring music as a mode of communication, and investigating how musicians creatively interact, provide a unique lens for understanding how we synchronize our actions and thoughts with those around us. Specifically, the analysis of the improvisational skills employed by jazz musicians to convey musical concepts and structure them coherently offers valuable insights into the intricacies of human interaction. Music therapists have successfully utilized such techniques for therapeutic engagement over the years, generating growing interest in examining communication from a musical perspective. The natural coordination of psychological elements on this level often remains obscured by layers of linguistic and societal norms, but a thorough, objective examination of music and musical performances can unveil these phenomena for scrutiny. This research suggests that music holds the potential to enhance both personal and interpersonal communication. It presents a framework for linking music and communication, contributing to a relatively underexplored field of study. [ABSTRACT FROM AUTHOR]

The collaborations between industry, university, and research institutes have become more relevant with the trend of knowledge commercialization, while whether there exists a "superstar" in R&D alliance networks, who played a key role in the diffusion and transfer of technology and knowledge, remains unexplored. Based on R&D activities information of joint patents in China, this study applied two-mode network analysis to understand the R&D alliance network of the industry-university-research institute (IUR) collaboration. Three types of networks, collaboration networks, knowledge networks, and inter-organizational technology networks among IUR are developed, and their evolution process is analyzed at different levels, including overall structure, individual characteristics, and temporal evolution among IUR. The results show that no permanent superstar is being the dominant position. Distinct modes have been emerging in different periods: in the formation period, the mode is U-R, I-U, U, R, I; in the growth period, the mode is I-R, I-U, I-U-R; in the mature period, the mode is I-U-R. In addition, different technology classes were aggregated in different periods. This paper attempts to provide countermeasures and recommendations for enterprises, universities, and research institutions to enable the success of their collaborations. [ABSTRACT FROM AUTHOR]

Qualitative exploration of the experience of psychoanalytic psychotherapy complemented the quantitative evaluation of mental health and life functioning improvements in the Melbourne Study of Psychoanalytic Psychotherapy. Twice‐weekly treatment was offered to adults for 2 years by the private sector Glen Nevis Clinic for Psychoanalytic Psychotherapy, established by the Victorian Association of Psychoanalytic Psychotherapists as a subsidized, low‐cost community service over 8 years. This paper is the second of two presenting the qualitative arm of the study, involving in‐depth narrative interviews with patients and psychotherapists. Analysis of 143 transcripts further contributes to evidence of the Reach, Effectiveness, Adoption, Implementation and Maintenance of psychoanalytic psychotherapy in a community setting. The first qualitative paper reports themes concerning patient expectations of psychotherapy and perspectives of both patients and psychotherapists on the experience and benefits of the treatment. This paper reports what was perceived by participants as facilitative or challenging for therapeutic progress, illuminating how experiences of the nature of psychoanalytic psychotherapy may have affected the Implementation, Effectiveness and Maintenance of the program. The most notable facilitative factors emerging were the exploratory, insight‐oriented nature of the work, elements of the patient‐psychotherapist relationship, and the frame of the treatment. Challenges were also often seen as inherent to Effectiveness; however, proposing the frame of 2‐year treatment, as both an expectation and a limit, probably inhibited program Reach, Adoption and overall Implementation. The limitations and strengths of the qualitative arm of the research, together with implications for further investigation, are discussed. [ABSTRACT FROM AUTHOR]

The naturalistic, longitudinal Melbourne Study of Psychoanalytic Psychotherapy was conducted in a subsidized community clinic established by the Victorian Association of Psychoanalytic Psychotherapists as a demonstration project operating over 8 years. It offered lower SES adults twice‐weekly psychoanalytic psychotherapy for 2 years. An independent research program used the RE‐AIM planning and evaluation framework to investigate the Reach, Effectiveness, Adoption, Implementation and Maintenance of the service. Complementary quantitative and qualitative methodologies studied mental health and general‐life functioning outcomes and underlying processes of treatment. Two papers present the qualitative arm of the research, exploring the lived experience of the psychotherapy, reported contemporaneously and retrospectively by patients and psychotherapists. This first paper details the qualitative design and methods employed. In‐depth semi‐structured narrative interviews during psychotherapy, upon completion at 2 years, and at an additional 8‐month follow‐up point for patients, were conducted. Analysis of the narrative transcripts of 143 participant interviews revealed themes regarding patient expectations of treatment and the perceptions of both patients and psychotherapists of the long‐term psychoanalytic psychotherapy experience and its benefits. Narratives thus provided evidence of the Reach, Effectiveness, Adoption, Implementation and Maintenance of the service. The findings enrich understanding of the effective processes underlying the outcomes of the quantitative arm of the study reported separately. The second qualitative paper presents the findings concerning participants' experiences of facilitative and challenging aspects of the treatment, as well as the implications of the qualitative findings overall. [ABSTRACT FROM AUTHOR]

The Melbourne Study of Psychoanalytic Psychotherapy examined the implementation, lived experience, and perceived therapeutic gains of psychoanalytic psychotherapy in a low‐cost, private‐sector community clinic. A first in Australia, this 8‐year demonstration project allowed naturalistic study of the impact and process of intensive, long‐term, time‐limited psychoanalytic psychotherapy delivered to self‐referred adults by clinicians with a common theoretical frame of practice. Presented in three papers, the research employed the RE‐AIM planning and evaluation framework, using complementary quantitative and qualitative methods, to study the psychotherapy service in terms of Reach, Effectiveness, Adoption, Implementation and Maintenance. This first paper reports the Reach of the program to be 67% for those presenting for assessment for psychoanalytic psychotherapy, with Adoption of the full 2‐year treatment program being 60%. Improvements in mental health and life functioning provided quantitative evidence of Effectiveness for those completing the 2‐year treatment program, with Maintenance at 8‐month follow‐up. Patient age, gender and personality characteristics did not modify these improvements. In‐depth qualitative exploration of patient and psychotherapist perspectives regarding the psychotherapy is reported in the second paper highlighting expectations, experience and benefits of the psychotherapy. The third companion paper presents the qualitative findings concerning factors experienced as facilitating or challenging therapeutic progress. Each of the three related papers amplifies understandings of how low‐cost, long‐term but time‐limited psychoanalytic psychotherapy can be implemented in the community with adults otherwise unable to afford such treatment, and discusses lessons learned. [ABSTRACT FROM AUTHOR]

The article investigates the phenomenon of unilateral termination (UT) in psychological treatment, where clients decide to end therapy without completing the initially intended goals. The study, conducted in an Irish outpatient adult mental health psychology service, employs a multi-perspective approach, gathering data from clients who unilaterally terminated, clients who engaged with planned endings, and practicing adult mental health psychologists.

Background: A critical policy issue in Australia and worldwide is the escalating rates of work-related mental injury that have been linked to the lack of help-seeking behaviours of at-risk workers. Strategic alliances between community organisations, statutory bodies, and mental health service providers could expand the efficacy and reach of mental health literacy and peer support initiatives that can encourage help-seeking, however, there is limited evidence to support the development of such approaches. This study used a qualitative design based on collaboration theory to explore the factors influencing community organisation leaders' decisions to provide such initiatives through collaboration with relevant third parties. Methods: Repositories of submissions into mental health reviews and publicly available registers in Australia were used to identify twenty-two participant organisations (n = 22), which were categorised according to the International Classification of Non-Profit Organisations (Culture & Recreation, Social Services, and Development & Housing). Eleven of these organisations demonstrated an interest in collaborating with third parties and extending efforts to deliver work-related mental health initiatives through contributions to mental health reviews. Leaders were interviewed to understand differences in perspectives on potential collaborations. Results: Organisations that did not make submissions were reluctant to engage in such efforts due to limitations in expertise/capacity, and perceived mission misalignment. Third-party support from statutory bodies and mental health service providers addressing these perceived limitations may improve their confidence, and willingness to engage. Regardless of their category, all considered the benefit of such collaboration included improving the acceptability, approachability, availability, and efficacy of work-related mental health initiatives. Equity was seen as supporting decision-making/leadership, while power imbalance was a barrier. Third-party contributions that could facilitate collaboration included expert support/credibility, administration, formal structures, supportive policy, and joining networks, however, red tape was a challenge. Shared values, vision, practice, and networking were identified as supporting positive communication and interpersonal relations. Conclusion: The study establishes that, adequately supported and resourced, community organisations are willing to align strategically with statutory bodies and mental health service providers to use their unique position in the community to deliver work-related mental health literacy and peer support programmes for at-risk workers to improve help-seeking behaviours. Highlights: This is the first study that used a qualitative approach guided by collaboration theory to explore the motivations influencing Community Organisation (CO) leaders' decisions to work with statutory bodies and mental health service providers and deliver programmes aimed to improve workers' access to mental health literacy resources and peer support. Understanding the beliefs that differentiate COs that provided submissions into mental health reviews from those that did not is imperative in the design of effective strategies to facilitate future engagement. The use of a theory-based decision-making model (the Strategic Alliances Framework) was critical in determining the scale, and types of initiatives that different categories of COs may be able to provide, and potential levels of engagement with relevant third parties. COs must be adequately guided, resourced, and supported by statutory bodies/regulators and organisations with mental health expertise if they are to meet the contemporary needs of their communities and achieve impact beyond work-related mental health awareness raising. [ABSTRACT FROM AUTHOR]

Introduction: Video psychotherapy (VPT) demonstrated strong clinical efficacy in the past, with patients and psychotherapists expressing satisfaction with its outcomes. Despite this, VPT only gained full recognition from the German healthcare system during the COVID-19 pandemic. As society increasingly relies on new media, it seems likely that VPT will become even more relevant. Previous studies surveyed practicing psychotherapists and patients about advantages and disadvantages of VPT. In contrast, our approach targets a younger generation, specifically psychology students intending to become licensed practitioners after graduation. Methods: Our mixed-methods study was conducted in an online survey format and had two main objectives. Firstly, we investigated which person-related variables are associated with psychology students' behavioral intention to offer VPT after graduation, using a multiple regression analysis. Secondly, we explored psychology students' perception of advantages and disadvantages of VPT and identified their desired learning opportunities regarding VPT in their study program, using qualitative content analysis. Results: A sample of 255 psychology students participated. The multiple regression model explains 73% of inter-individual variance in the intention to offer VPT, with attitudes toward VPT showing the strongest relationship with intention to offer VPT. Expected usefulness, satisfaction with video conferencing, and subjective norm also showed significant relations. The students provided 2,314 statements about advantages, disadvantages, and desired learning opportunities, which we coded by means of three category systems. In terms of advantages, the most frequently mentioned categories were low inhibition threshold, flexibility in terms of location, and no need to travel. For disadvantages, the predominant categories included lack of closeness between patient and psychotherapist, lack of nonverbal cues, and problems with technology or internet connection. Regarding desired learning opportunities, training for technical skills, practical application through role-playing and self-experience, and general information about VPT were the most mentioned categories. In addition, we identified numerous other aspects related to these topics, reflecting a differentiated and balanced assessment of VPT. Discussion: We discuss the theoretical and practical implications of our findings for training the next generation of psychotherapists and outline a specific fivestep plan for integrating VPT into study programs. [ABSTRACT FROM AUTHOR]

Background: The prevalence of anxiety and depression disorders is surging worldwide, prompting a pressing demand for psychological interventions, especially in less severe cases. Responding to this need, the Italian government implemented the "Psychological Bonus" (PB) policy, allotting 25 million euros for mental health support. This policy entitles individuals to a minimum of four to twelve psychological sessions. In collaboration with the National Board of Italian Psychologists, our study assesses this policy's effectiveness. Indeed, the PsyCARE study aims to examine the utilization of the Psychological Bonus, evaluate its impact on adult and adolescent participants' psychological well-being through pre- and post-intervention assessments and six-month follow-up, and conduct a longitudinal cost-effectiveness analysis of this policy. A secondary aim is to investigate the influence of these interventions on transdiagnostic factors, including emotion regulation and epistemic trust. Methods: The study involves licensed psychotherapists and their patients, both adults and adolescents, benefiting from the Psychological Bonus. Data collection is underway and set to conclude in December 2023. Psychotherapists will provide diagnostic information and assess patient functioning. In addition, patients will be evaluated on mental health aspects such as clinical symptoms, emotion regulation, epistemic trust, and quality of life. We will employ linear mixed-effects models to analyze the outcomes, accounting for both fixed and random effects to capture the hierarchical structure of the data. Discussion: We anticipate the study's findings will highlight reduced psychological distress and improved quality of life for participants and demonstrate the Psychological Bonus policy's cost-effectiveness. The study will gather data on the role of specific versus nonspecific therapeutic factors in psychotherapy while adopting a patient-tailored approach to identify effective therapeutic elements and examine transdiagnostic factors. Overall, this study's findings will guide future measures within the Italian healthcare system, fostering a psychological health culture and providing valuable insights to the broader public. Study registration: https://osf.io/6zk2j [ABSTRACT FROM AUTHOR]

Phobias are a type of anxiety disorder characterized by severe fear of objects and situations. In recent years, virtual reality exposure therapy has emerged as a safer and more convenient method of treating phobias, with the same rate of success as classical therapy, the in vivo exposure to stimuli. Following extensive research concerning the available technologies and after studying the state of the art in the field, we developed the PhoVR (Phobia therapy through Virtual Reality) system during a 2-year long project that involved the participation of a technical university, a biology faculty, and an industry partner specialized in designing 3D applications. Our final prototype incorporates scenarios for acrophobia, claustrophobia, and fear of public speaking therapy, in which the user is required to perform gamified tasks and navigate virtual reality environments with biophysical data acquisition (electrodermal activity and heart rate), automatic anxiety level classification, biofeedback integrated into the scenes' elements, the dynamic adaptation of the virtual environments, and relaxation techniques made available at any moment. The control panel is an application dedicated to psychotherapists for managing patients' profiles and therapy sessions. The feedback obtained in a qualitative survey with subjects and psychotherapists who evaluated the prototype validated the system and provided suggestions for refinement. [ABSTRACT FROM AUTHOR]

In fact, the author observes, "just as any other couple immersed in long-term and emotionally intense social interaction, a psychoanalyst and a patient can end up locked in a profound, or total, silence for long periods of time. Slowly the analyst came to interpret how her experience of helplessness and painful frustration had reflected reversed roles the traumatic-dissociated experience of Susan as a child "in relationship to her critical aggressive mother and to her distant but idealized father" (p. 117). Silence and Silencing in Psychoanalysis: Cultural, Clinical, and Research Perspectives, edited by Aleksandar Dimitrijevi'c and Michael B. Buchholz, Routledge, Abingdon and New York, 2021, 386 pp. [Extracted from the article]

In recent years, especially in the era of the COVID-19 pandemic, we have witnessed a partial transition in the field of psychotherapy from in-person settings to remote ones (i.e., online therapy). This trend has raised the question of whether the two settings are interchangeable. With the research described here, the authors explore, within a transactional analysis theoretical framework, whether the therapeutic impact of in-person sessions, assessed by both patients and therapists, is different from that perceived with a remote setting. Using the Session Evaluation Questionnaire (SEQ), 20 transactional analysis psychotherapists and their patients evaluated the impact of two pairs of sessions—one in person and one online—for a total of 160 SEQs. The data were then analyzed through t-tests to verify the research hypotheses. For therapists only, the impact of remote sessions was perceived to be lower than that of in-person sessions. The implications are discussed from a clinical point of view. [ABSTRACT FROM AUTHOR]

This study aimed to understand the therapeutic relationship in a virtual environment from the therapist's perspective, considering the digital resources used by therapists in online psychotherapy. The research adopts a qualitative methodological approach based on grounded theory and involves three therapists experienced in both face-to-face and online psychotherapy. Data were collected in the digital world through field journals and in-depth interviews. The results highlight that the therapeutic relationship is formed through virtual interactions by appropriating the media ecosystem, an environment co-created by the therapist and the patient. It is concluded that, from the therapist's experience, the formation of the therapeutic relationship begins with the first digital contact, and the content and media used gradually shape the virtual experience, framing the therapeutic context. [ABSTRACT FROM AUTHOR]

The push to systematically follow treatment outcomes in psychotherapies to improve health care is increasing worldwide. To manage psychotherapeutic services and facilitate tailoring of therapy according to feedback a comprehensive and feasible data system is needed. To describe the Finnish Psychotherapy Quality Register (FPQR), a comprehensive database on availability, quality, and outcomes of psychotherapies. We describe the development of the FPQR and outcome for outsourced psychotherapies for adults in Helsinki and Uusimaa hospital district (HUS). Symptom severity and functioning are measured with validated measures (e.g. CORE-OM, PHQ-9, OASIS, AUDIT, and SOFAS). Questionnaires on therapeutic alliance, risks, methods, and goals are gathered from patients and psychotherapist. During 2018–2021, the FPQR included baseline data for 7274 unique patients and 336 psychotherapists. Response rate of measures was 85–98%. The use of the register was mandatory for the outsourced therapist of the hospital districts, and the patients were strongly recommended to fulfill the questionnaires. We report outcome for three groups of patients (n = 1844) with final/midterm data. The effect sizes for long psychotherapy (Hedge's g = 0.65 of SOFAS) were smaller than those for short psychotherapy (g = 0.75–0.91). Within three months of referral, 26–60% entered treatment depending on short- or long-term therapy. The FPQR forms a novel rich database with commensurate data on availability and outcomes of outsourced psychotherapies. It may serve as a basis for a national comprehensive follow-up system of psychosocial treatments. The Finnish system seems to refer patients with milder symptoms to more intensive treatments and achieve poorer results compared to the IAPT model in UK, Norway, or Australia. [ABSTRACT FROM AUTHOR]

The present paper is an attempt to explore the actual and potential convergences and divergences of the ontological-existential philosophy of Martin Heidegger and Freud's analytic thinking as well as later developments in psychoanalysis. The first part of the paper compares and contrasts Freud's and Heidegger's thinking on issues of truth and anxiety, which are central to their respective doctrines and highly relevant to working with difficult patients. It is shown that both Freud's psychoanalytic theory and Heidegger's ontological philosophy stress the process of opening up to the anxiety-evoking truth and the individual's responsibility to uncover the truth as a source of freedom. The second part of the paper examines the impact of Heidegger's thought on the psychoanalytic understanding of individuals with severe character pathology, on the spectrum from malignant narcissism, through perverse organizations, to psychosis. In this context, the authors discuss the notion of 'anxieties of being,' a shift towards a more ontological psychoanalysis and the phenomenologisation of psychoanalytic language. Viewing people as interpretive creatures, the authors believe that Heidegger's hermeneutic outlook may enable psychoanalysts to approach their patients in a more open and accepting manner. [ABSTRACT FROM AUTHOR]

Background: Individuals with different attachment classifications (Secure, Avoidant and Preoccupied) may experience emotional closeness differently, in their intimate relationships but also as clients in psychotherapy. However, evidence for this assumption almost exclusively comes from research with selfreport questionnaires. Aims: In this paper, we use observer-rated measures to explore in depth how patients with different attachment classifications experience closeness and distance from the therapist in different phases of therapy. Method: Three patients' and their therapists' narratives about the therapeutic relationship at three time points during therapy were extracted and analyzed with two transcript-based observational measures: The Patient Attachment Coding System (PACS), which classifies patients' attachment according to their discourse behavior, and the therapeutic-Distance Scale-Observer version (TDS-O), which assesses the therapeutic relationship in terms of closeness, distance, autonomy and engagement. Cases were chosen from a larger research project due to their different prototypical attachment classification on the PACS. The narratives were obtained from Relationship Anecdote Paradigm (RAP) interviews in which the patients and their therapists narrated separately about meaningful interactions with each other, at early, middle and late phases of therapy. In addition, we followed patients self-report of the alliance and symptoms (OQ-45). Results: Although all patients reported experiencing discomfort with feeling distant from the therapist the therapeutic distance, the secure patient was able to reflect on his feelings and, in the therapist's recollection, was able to share them with the therapist. This allowed the therapist to harness these feelings for the benefit of the therapy. The avoidant and the preoccupied patients both experienced the therapist as distant, but the avoidant patient prevented closeness by a minimal expression of feelings, and the preoccupied described strong frustration with the therapist in a one-sided manner that prevented collaborative processing and left the therapist confused. Discussion: It appears that patient discourse is a stable (trait-like) component of attachment, while the therapeutic-distance is a process (state-like) component that may change along therapy. The discourse of insecure patients may hinder therapists' ability to adjust the therapeutic-distance to patients' needs. Therapists' knowledge about the ways patients with different attachment classifications communicate their proximity wishes may improve their attunement. [ABSTRACT FROM AUTHOR]

Introduction: Psychotherapy added to usual hospital care is beneficial. This study reports on two contrasting cases, one responder and one nonresponder, from a randomized controlled trial on the effectiveness of intensive and brief psychodynamic psychotherapy (IBPP) for depressed inpatients, in which reduction in depressive severity was maintained for up to 1 year after completion of IBPP. We aimed to explore how the psychotherapist and patient interacted to work through the themes of focalization (described in the IBPP manual) and how their work was part of a potential process of change. Methods: This case study is part of the general framework of mixed methods in psychotherapy combining quantitative analysis of data collected in a randomized controlled trial with a qualitative case study. Results: Two general categories emerged--(1) becoming the subject of one's depression and (2) regaining a sense of suppor--which combine specific functions. In the first, the functions relate to interactions in line with the psychoanalytic work of mourning, which aims for an appropriation of depressive symptoms. In the second, interactions have as their functions the construction of a therapeutic space and the restoration of an epistemic trust by acknowledging the patient's melancholic state and maintaining emotional contact. Work related to regaining a sense of support was observed in both cases, whereas work related to becoming the subject of one's depression was more specific to the responder case. Discussion: These results highlight the importance of interventions that help generate a sense of support and mobilize the internal processes of symbolization, understanding, and appropriation, leading patients to develop the capacity to give meaning to their symptoms and to understand the personal psychological factors related to the depressive episode. [ABSTRACT FROM AUTHOR]

Objective: In the wake of the COVID‐19 pandemic, the use of teletherapy has become more pervasive than ever. Many therapists faced this move to a remote setting with little experience or training. We aimed to qualitatively examine therapists' subjective experience of providing teletherapy, including changes in technique, the therapeutic relationship, and the therapeutic process. Methods: Thirty‐one psychotherapists participated in semistructured interviews. Interviews were recorded, then transcribed and analyzed using the Consensual Qualitative Research method. Results: Therapists typically reported a change in the therapeutic relationship in terms of an increased sense of disconnection as well as shifts in various aspects of the relational dynamics, and they also typically experienced differences in the therapy process due to changes in patient and therapist engagement in the therapeutic work. Additionally, some therapists also reported that they became more active and directive in sessions, took a more informal, personal, or relaxed approach to interacting with patients, and while the emotional connection changed and they missed the energy and intimacy of in‐person sessions, the relationship in telesessions felt more authentic and human for some, and teletherapy also provided a way to discuss new dimensions in the process. Conclusion: Overall, these results suggest great variability in therapists' subjective experiences with teletherapy, and present teletherapy as a distinct therapy format in many aspects. Further process‐level research and subsequent training is needed to better equip therapists to navigate teletherapy's challenges and harness its unique opportunities. [ABSTRACT FROM AUTHOR]

Introduction: Depression is a common and severe comorbidity among individuals with heart failure (HF). Up to a third of all HF patients are depressed, and an even higher proportion have symptoms of depression. Aim: In this review, we evaluate the relationship between HF and depression, explain the pathophysiology and epidemiology of both diseases and their relationship, and highlight novel diagnostic and therapeutic options for HF patients with depression. Materials and Methods: This narrative review involved keyword searches of PubMed and Web of Science. Review search terms included ["Depression" OR "Depres*" OR "major depr*"] AND ["Heart Failure" OR "HF" OR "HFrEF" OR "HFmrEF" OR "HFpEF" OR "HFimpEF"] in all fields. Studies included in the review met the following criteria: (A) published in a peer-reviewed journal; (B) described the impact of depression on HF and vice versa; and (C) were opinion papers, guidelines, case studies, descriptive studies, randomized control trials, prospective studies, retrospective studies, narrative reviews, and systematic reviews. Results: Depression is an emergent HF risk factor and strongly relates with worse clinical outcomes. HF and depression share multiple pathways, including platelet dis-reactivity, neuroendocrine malfunction, inappropriate inflammation, tachi-arrhythmias, and frailty in the social and community setting. Existing HF guidelines urge evaluation of depression in all HF patients, and numerous screening tools are available. Depression is ultimately diagnosed based on DSM-5 criteria. There are both non-pharmaceutical and pharmaceutical treatments for depression. Regarding depressed symptoms, non-pharmaceutical treatments, such as cognitive-behavioral therapy and physical exercise, have shown therapeutic results, under medical supervision and with an effort level adapted to the patient's physical resources, together with optimal HF treatment. In randomized clinical studies, selective serotonin reuptake inhibitors, the backbone of antidepressant treatment, did not demonstrate advantage over the placebo in patients with HF. New antidepressant medications are currently being studied and could provide a chance to enhance management, treatment, and control of depression in patients with HF. Conclusions: Despite the substantial link between depression and HF, their combination is underdiagnosed and undertreated. Considering the hopeful yet unclear findings of antidepressant trials, further research is required to identify people who may benefit from antidepressant medication. The goal of future research should be a complete approach to the care of these patients, who are anticipated to become a significant medical burden in the future. [ABSTRACT FROM AUTHOR]

Introduction: The therapeutic relationship continues to be one of the most important factors in therapeutic outcomes. Given the place of emotion in the definition of the therapeutic relationship, as well as the demonstrated positive impact that emotional expression has on therapeutic process and outcome, it stands to reason that studying the emotional exchange between the therapist and client further would be warranted. Methods: This study used a validated observational coding system--the Specific Affect Coding System (SPAFF) and a theoretical mathematical model to analyze behaviors which make up the therapeutic relationship. Specifically, the researchers used to codify relationship-building behaviors between an expert therapist and his client over the course of six sessions. Dynamical systems mathematical modeling was also employed to create “phase space portraits” depicting the relational dynamics between the master therapist and his client over six sessions. Results: Statistical analysis was used to compare SPAFF codes and model parameters between the expert therapist and his client. The expert therapist showed stability in affect codes over six sessions while the client’s affect codes appeared to be more flexible over time, though model parameters remained stable across the six sessions. Finally, phase space portraits depicted the evolution of the affective dynamics between the master therapist and his client as the relationship matured. Discussion: The clinician’s ability to stay emotionally positive and relatively stable across the six sessions (relative to the client) was noteworthy. It formed the basis for a stable base from which she could explore alternative methods to relate to others that she had allowed to dictate her actions, which is in keeping with previous research on the role of therapist facilitation of the therapeutic relationship, emotional expression within the therapeutic relationship, and influence of these on client outcomes. These results provide a valuable foundation for future research on emotional expression as a key component of the therapeutic relationship in psychotherapy. [ABSTRACT FROM AUTHOR]