Search

Objective: Explore experiences of and attitudes towards deliberate practice and virtual reality (VR) among therapists in child and adolescent psychiatry, and what clinical situations are perceived as particularly relevant for practice. Methods: 59 therapists completed an anonymous online survey. Results: Participants had limited experience with deliberate practice and VR, but were generally very positive to trying this framework to develop therapeutic skills. Situations where caregivers were angry were perceived as the most challenging, while situations where clients were quiet and passive were the most frequent. The perceived challenge of different situations varied widely among participants. Implications: The results are used to reflect upon development of therapeutic skills among licensed therapists in general, and within mental health care in particular. Keywords: therapist development, deliberate practice, VR, difficult clinical situations, child and adolescent mental health care

Mental health challenges can interfere with caregivers' self-efficacy and their ability to engage with their children in developmentally appropriate ways. The goal of this study was to explore whether the intervention Circle of Security Parenting (COS-P) was experienced as a meaningful adjunct to psychological treatment.Individual qualitative semi-structured interviews were conducted with twelve female COS-P participants, exploring how taking part in COS-P had changed the way they related to themselves and others. Data were analyzed using a team-based, reflexive thematic analysis.The analysis resulted in three main themes: (i) Connecting dots: A new perspective on one's past, (ii) Seeing oneself more clearly: Increased capacity to recognize and tend to own needs, and (iii) Gaining a map: Becoming a more competent parent.Taking part in COS-P as an adjunct to psychological treatment positively impacted participants' sense of competence as mothers. They used the COS-P framework to make sense of their interaction with their child, enabling them to understand the child's behaviour and communication as expressing legitimate attachment needs. They also experienced that the course strengthened central psychological capacities, such as insight into their own developmental histories as well as increased self-awareness and self-care. Implications are discussed.

Does working with suicidal patients become easier with time? A representative national survey of 375 psychologists (72% women, Mean age 44 years) showed that years of experience (r = −.13, p = .01)...

This study took a qualitative approach to explore terror-bereaved parents’ long-term experiences with grief. Data were drawn from a larger, longitudinal study, and interviews with 10 bereaved parents were selected based on their reported change in scores on Inventory of Complicated Grief (ICG) over a period of 6.5 years, including the five parents with the largest change (group 1) and the five parents with the least change (group 2). Reflexive thematic analysis of the interview transcripts resulted in four main themes: “I felt completely lost and helpless, like I was stuck in a whirlwind” and “I have been fighting to get back to my everyday life”, which both groups contributed to. Participants in group 1 contributed to the theme “I have found a way to a new life,” while participants in group 2 contributed to the theme “I cannot seem to find a way to a new life.” Findings suggest that sense of control, acceptance, and social support enhanced experienced coping following terror-related bereavement, while comorbid mental health problems, difficulties with acceptance, and repetitive thoughts about the death was experienced as contributing to long-term struggles following terror-related bereavement. publishedVersion

Background: Many adolescent clients come to treatment reluctantly, at the initiative of others. Adolescents also quit therapy prematurely more often than adult clients do. This points to the value of finding good ways to engage adolescent clients in treatment and understanding more of what therapists do to achieve this task.Methods: We used focus group methodology to explore therapist strategies and behaviors to engage adolescent clients who come to therapy at the initiative of others. Ten focus group interviews with a total of 51 therapists were conducted with existing treatment teams from seven different clinics in community mental health care for children and youth. Reflexive thematic analysis was used as a framework to guide the analytical process.Findings: Navigating a position allowing the therapist and adolescent to meet and work toward a shared understanding of the situation and what could help was considered the main gateway to client engagement. To do this, therapists had to manage the pull between system requirements and their obligation to the individual adolescent client, represented by the theme Managing system requirements. The process of working with the adolescent to ensure engagement is represented by the four themes: Counteracting initial obstacles for client engagement – “You are not trapped here”; Sharing definitional power – “What does it look like to you?”; Practicing transparency – “I want you to know what I see”; and Tailoring as ideal – “I will design this therapy for you.”Implication and conclusion: Therapists want to understand their adolescent clients’ position better, and subsequently adjust the treatment goals and techniques to establish sufficient common ground to allow both the therapist and adolescent to find the therapeutic project worthwhile. However, system requirements and service organization were found to obstruct and influence these processes in several ways, pointing to the significance of exploring the interplay between system organization and therapeutic practice more thoroughly. There was also a variation between therapist behaviors described by different therapists within the same treatment teams, as well as systematic differences between treatment teams, pointing to the importance of future research differentiating wanted from unwanted variation in treatment.

Social factors seem to play an important role in people’s recovery processes, yet little attention has been given to such aspects in relation to early psychosis. In this study, we explored how youn...

In this pilot study, we examined whether a 2-day Emotion-Focused Family Therapy workshop strengthened parental self-efficacy, satisfaction and beliefs regarding their ability to help their children...

Background There is growing evidence for the efficacy of group-based interventions for adults with ADHD. However, there is still a lack of research investigating how clients experience participating in such interventions. The aim of the current study was to explore how adults with ADHD experience participating in a group-based intervention (Goal Management Training) for ADHD. Method We conducted individual, semi-structured, interviews with ten adults with ADHD who had participated in Goal Management Training administered as a group intervention. The interviews were transcribed verbatim and analyzed using thematic analysis within a hermeneutic phenomenological framework. Results Our analysis identified three main themes. The participants’ starting point captured the participants’ motivation and expectations prior to treatment. The ambiguity of the group – the various meanings of the group consisted of three sub-themes (The group created a sense of belonging - “I am not alone”; The personal cost of participating in the group - “At times it was a hot mess”; and The group supported the learning experience - “We worked with it together”). The group promoted positive change – How the group affected the participants’ everyday lives consisted of two sub-themes (Managing ADHD in daily life - “It’s much easier to handle everyday life”, and Personal growth - “Gaining new perspectives”). Conclusion The group format was experienced as a valuable aspect of treatment. The structure provided by Goal Management Training allowed participants to expand their perspectives and experience improved management of ADHD, as well as personal growth. The opportunity to exchange experiences with others in similar situations was seen as particularly beneficial and brought feelings of recognition and belonging. However, some also experienced the group as a burden at times, for instance by stealing one’s focus. This study expands existing knowledge by exploring clients’ experiences of participating in group-based interventions for ADHD and shows how the group format provided participants with more than they had hoped for. While expecting a more instrumental outcome of treatment, such as tools to manage ADHD, participants also gained a welcomed, but unexpected outcome of personal growth.

The purpose of this study was to explore what adult survivors of child sexual abuse (CSA) believe will facilitate early disclosure of sexual abuse. We conducted semi-structured interviews with 12 adult survivors of CSA aged 18–57 years, and analyzed the transcripts using reflexive thematic analysis. Our analysis resulted in three main themes: Adults making it possible to tell; Adults daring to consider the unthinkable; and Conveying knowledge of CSA that facilitates understanding. The findings highlighted the importance of adults facilitating disclosure and making it possible for survivors to tell about their experiences, but also the responsibility adults have to dare to consider the possibility of CSA when children struggle. Another important finding was the significance of enhancing the general population's understanding of the complexity of CSA, including why disclosure is difficult, so adults are given the tools needed to understand and know what to do when they suspect CSA. The findings also have important implications for the planning and implementation of interventions to facilitate early disclosure of CSA.

In this study, we conducted qualitative in-depth interviews to explore how clients experienced working with emotional processing and self-criticism in a two-chair dialogue intervention. Eighteen cl...

Trauma exposure is widespread in the general population. Despite the proposal that mindfulness practice could be beneficial for treating persons exposed to traumatic events who go on to develop PTSD and/or correlates of past trauma, there are very few mindfulness-skills programs that directly target trauma survivors. This paper seeks to use existing empirical research and theory to explore the potential and challenges of using mindfulness-based interventions to treat trauma-related problems. Through the lens of the group program, Mindfulness and Compassion: the path to growth after trauma (TMC), we explore the potential of integrating trauma-sensitive mindfulness explicitly with compassion training for trauma survivors. This paper seeks to contribute to development of psychological treatment by the methods of mindfulness and compassion training and how they may be used as a complementary or a stand-alone treatment option in phase-based treatment for complex PTSD.

We conducted a study to explore how people diagnosed with first-episode psychosis experienced their contact with early intervention services for psychosis and the way these experiences relate to their recovery processes. Our aim was to integrate and describe the service users' experiences in a rigorous and comprehensive way. A broad literature search was performed in June and July 2016. After screening, 17 qualitative studies were included. We analyzed the findings in two main steps: (a) translating studies into one another and (b) synthesizing the findings from the studies. Through these interpretative processes, we found five new and overarching themes: (a) something is wrong, (b) do for myself, (c) it's about people, (d) a price to pay, and (e) ongoing vulnerability. We describe these themes as a process that service users' maneuver through in their contact with the services. Our findings are discussed in light of relevant research.

Traditionally, there has been a sharp division between ‘personal’ and ‘clinical’ recovery. What role, then, might therapy play in personal recovery? To explore how female adult trauma survivors experience working towards recovery after participation in trauma-specific group therapy, we carried out semi-structured qualitative interviews with 13 clients one year after their completion of a stabilization group approach. A hermeneutic-phenomenological approach was used to analyze interview transcripts. After therapy, the participants consolidated and continued their positive processes of change. Experiences from therapy gave rise to personal recovery processes that were categorized into two main themes: “tapping into pre-therapy resources” and “using therapy-related resources.” Therapy might play an important role in personal recovery through helping clients to rediscover and utilize existing resources, as well as being a source of new resources. The participants were active agents in this recovery, putting their therapies to use in the context of their daily living.

This qualitative study investigated ways in which student participants in a three-session self-compassion course became more compassionate toward themselves and challenges related to this change. Ninety-four participants completed an online survey and 12 participants were interviewed face-to-face. First, a thematic analysis of the responses from the online survey was conducted, and then sorted by frequency, indicating their representativeness in the written responses. The following themes were identified: (1) being more supportive and friendlier toward self, (2) being more aware of being too hard on oneself, (3) feeling less alone when having painful feelings, (4) having more acceptance of painful feelings, and (5) feeling more stable and peaceful. These five most frequent themes served as a basis for a structured phenomenological analysis in the next analytic stage. They were used as a template for a content analysis of the interview material. Subsequently, a phenomenological analysis was conducted on the interview transcripts covering the five thematic areas publishedVersion

Background: The therapeutic relationship is regarded as an important source of change in Emotion-Focused Therapy (EFT) (Greenberg, 2014; Watson, 2018), but few qualitative studies have specifically investigated how clients experience the role of the relationship in EFT. Aim: The purpose of the present study was to explore what clients experienced as helpful or hindering aspects of the therapeutic relationship when undergoing EFT for depression, anxiety and severe self-criticism. Method: We interviewed 18 clients after a clinical trial of time-limited EFT, to explore their experiences of the relationship with their therapist during treatment. The interviews were analyzed using hermeneutic-phenomenological thematic analysis (Braun & Clarke, 2006; Binder, Moltu & Holgersen, 2012). Results: We identified four main themes: (1) Forming a trusting relationship or finding it hard to connect, (2) Collaborating and struggling to find new ways to relate to painful feelings, (3) Alliance ruptures and needs for repair when working with distressing emotions, and (4) The significance of new relational experiences. Conclusion: Clients described therapists’ genuineness and the establishment of trust in the relationship as important preconditions to open up to vulnerability and painful feelings, and engaging fully in specific EFT interventions. The findings also indicate that the therapists need to be mindful of different client preferences and monitor potential alliance ruptures when working to change distressing emotions in therapy.

Psychotherapy research has demonstrated the significance of therapists’ interpersonal skills for outcome. This raises the question of what interpersonal situations psychologists perceive to be challenging and how we can train psychologists to master such situations. A web-based questionnaire was sent to a representative sample of Norwegian psychologists, mapping frequency and perceived demand of potentially challenging interpersonal situations in therapy. The results showed that suicidality was perceived as the most demanding situation, while clients expressing intense emotions was the most commonly encountered situation. Three of the most demanding situations (suicidality, difficulty establishing common focus, and passive clients) were among the most commonly encountered situations. While work context (specialized mental health care or not) was associated with significantly higher frequency of the most common situations, work context had no impact on perceived difficulty of situations. Keywords: Interpersonal skills; therapist development; suicidality; difficult clinical encounters; therapist training

While child sexual abuse is recognized as a global challenge in need of attention, all too often it takes years before sexual abuse is disclosed. We therefore need to understand more of the process leading to disclosure of child sexual abuse. The purpose of this study was to investigate how adult survivors of child sexual abuse came to understand that they had been sexually abused. We conducted semi-structured interviews with 8 women and 3 men (18-57 years old) and analyzed the interview transcripts using a hermeneutic-phenomenological approach to thematic analysis. Our analysis resulted in three main themes

Background Intervening at an early stage of psychosis improves the chances of recovery from first-episode psychosis. However, people who are experiencing distress and early psychotic symptoms generally seem to delay seeking help. Therefore, multifaced information campaigns targeting help-seeking behavior of potential patients and their network are considered important tools within early detection and intervention strategies. In this study, we aimed to explore which discursive meaning content, including roles and actors, such information campaigns build on and construct. Our intention was not to provide objective answers, but to contribute to a discursive debate about potential conflicts in messages conveyed in such campaigns. Methods A broad sample of information material utilized by TIPS Stavanger University Hospital (Norway) was examined. The material consisted of posters, booklets and brochures, newspaper ads, Facebook ads, and TIPS Info’s website, representing various campaigns from 1996 to April 2018. A narrative discursive approach was applied at an epistemological level. At a practical level, a team-based thematic analysis was utilized to identify patterns across data. Results Diversity and several changes in strategy were recognized throughout the information material. Furthermore, three main themes and four subthemes were found to constitute the meaning content built in the information campaigns: knowledge is key; (almost) an illness among illnesses; and we all have a responsibility (comprising of the subthemes; to respond quickly; to step in; to provide an answer; and to tag along). Conclusion Our findings pointed to common dilemmas in mental health services: How to combine professional expert knowledge with collaborative practices that emphasize shared decision-making and active roles on behalf of patients? How to combine a focus on symptoms and illness and simultaneously express the importance of addressing patients’ recourses? And how can we ask for societal responsibility in help-seeking when professionals are placed in expert positions which may not be optimal for dialogue with potential patients or their network? We discuss whether highlighting practices with more weight on resources and active roles for patients and their surroundings in information campaigns could promote earlier help-seeking. Electronic supplementary material The online version of this article (10.1186/s13033-019-0289-4) contains supplementary material, which is available to authorized users.

Background: Child sexual abuse (CSA) is a serious threat to a child’s existence and development. Yet, on average it takes 17 years before victims disclose their abuse. Objective: The purpose of this study was to explore barriers to disclose sexual abuse from the perspective of adult survivors of CSA. Participants and Setting: 12 survivors of CSA (nine women and three men), aged 18–57 years old. The study was conducted in one of the largest cities in Norway where there has been a particular focus on disclosure of sexual abuse. Methods: We conducted semi-structured interviews, and interview transcripts were analyzed using a hermeneutic-phenomenological approach to thematic analysis. Results: Our analysis resulted in three themes: Fear of reprisals; CSA stains – Negative implications for self-representation; and The complicating effect of ambiguity. Conclusions: Our main finding was that CSA affects self-representation in ways that become significant barriers to disclosure. An important and unexpected implication of our findings is that society’s focus on informing people about CSA to facilitate disclosure, might instead, work as a barrier. Thus, it is crucial to explore this potential effect further when developing future interventions to facilitate early disclosure of CSA.

This article presents a narrative case study of a client with a history of multiple traumas and severe symptomatology, coupled with an ongoing recovery process. A hermeneutical–phenomenological approach was used to analyze two interviews with the participant over a period of 1 year, following a trauma treatment program. Her husband’s suicide in between the two interviews allowed for an exploration of the possible effects of new trauma exposure on the process of recovery. Analysis of the data revealed how the participant’s early trauma experiences had resulted in escalating symptomatology. Through her relationship with her husband, she gradually became ready to engage in therapy in a way that allowed her to benefit from it. Her husband’s suicide forced her to reconsider her own part in her recovery, resulting in a strengthened feeling of inner security and self-efficacy parallel to what is seen in posttraumatic growth. The results contribute our understanding of individual processes of change and recovery, including processes of growth following cumulative trauma. Plausible mechanisms for growth in the present case was the ability to recognize and tolerate feelings, making sense of one’s own reactions, as well as a sense of control and trust in available resources.

In this article, we report from a qualitative study investigating whether and how parents experience Emotion-Focused Family Therapy’s (EFFT’s) impact on the relationship to their children. Six parents who had attended a two-day course of EFFT were interviewed, with qualitative in-depth interviews taking place two to four months after completion of the course. We used a hermeneutic-phenomenological approach in analyzing these interviews. Analysis resulted in four main themes: Increased understanding of the child; Stronger confidence in their role as parents; Increased focus on emotions improving relationships; and Improved communication with the child. The study shows how the parents experienced becoming more secure in their role as parents and obtaining increased confidence in their own abilities. In addition, they experienced improved contact with, and better understanding of, their children. The parents underscored how these processes were ongoing and demanding and how they entailed considerable effort. Further research will contribute to expanding and nuancing our knowledge on how parents experience receiving EFFT and how such therapy affects parents’ experiences of their relationships with their children.

In this article we explore the process leading to help seeking following childhood trauma among women who were currently in treatment. We interviewed 13 participants from six treatment groups for clients exposed to human-inflicted traumas. Transcripts were analyzed using a hermeneutical-phenomenological approach. Help seeking was initiated after a prolonged period of time (13 to 58 years after first trauma exposure), during which participants relied heavily on a strategy of managing on their own. Self-management contributed to delays in help seeking, but was also an important resource. High levels of distress were reported prior to help seeking, often without help seeking being considered as an option. The participants sought help when encountering situational demands exceeding available resources, resulting in experiences of exhaustion and loss of control. We present a model of the help-seeking process, underlining the importance of respecting and exploring the individual process of seeking help when offering trauma-specific treatment.

The present study explores how trauma clients experience participation in an inclusive stabilization group approach. Upon completion of treatment, all 31 clients from six stabilization groups for women were invited to participate in a qualitative post-therapy interview study. Thirteen clients consented to participate. All interviews were carried out by a team of three health-care workers shortly after completion of treatment. Five main themes were identified: Dreading and Hoping— Preparing for Participation; Tuning in and Staying Put; Meeting Other Trauma Survivors; Acquiring a Stabilizing Ballast; and Being Receptive to Change. Participating in the stabilization group was experienced as demanding, while also providing new and helpful experiences. Participants emphasized the importance of being receptive to help in order to benefit from treatment.

The aim of this study was to explore how female survivors of childhood trauma who have sought treatment experience ways to positive change. Little knowledge exists regarding the first-person perspective of the recovery process following childhood trauma, and getting access to this perspective might contribute to better understanding of these processes, hence offering opportunities for health promotion. All clients (31, including 3 who dropped out) from six stabilization groups for women exposed to human-inflicted traumas were invited to participate in the study. Experiences of the recovery process were not restricted to the period of receiving treatment, and all clients who volunteered were included in the study. Qualitative, in-depth interviews with 13 consenting clients were carried out shortly after completion of the group treatment. All interviews were transcribed verbatim, and a hermeneutical-phenomenological approach to analysis was applied. The analysis resulted in five interrelated, but distinct main themes: finding new ways to understand one's emotions and actions, moving from numbness toward vital contact, becoming an advocate of one's own needs, experiencing increased sense of agency, and staying with difficult feelings and choices. The themes support, yet supplement trauma theory, by underlining the relationship between emotional contact and meaning-making, while downplaying the necessity of symptom elimination in the experience of recovery. The findings also underline that the active role trauma survivors play in their processes of recovery.

The primary aim of this study was to examine the effects of a two-week self-compassion course on healthy self-regulation (personal growth self-efficacy and healthy impulse control) and unhealthy self-regulation (self-judgment and habitual negative self-directed thinking) in university students. We also examined the effects on self-compassion, anxiety and depression. Students (N = 158, 85% women, mean age = 25 years) were randomized to an intervention group and a waiting-list control group in a multi-baseline randomized control trial. Healthy self-control was measured by the Personal Growth Initiative Scale (PGIS) and the Self-Control Scale; unhealthy self-control was measured by the Non-judgement subscale from the Five-Facet Mindfulness Questionnaire (reversed) and the Habit Index of Negative Thinking (HINT). Secondary outcomes were measured by the State-Trait Anxiety Inventory (STAI-trait), the Major Depression Inventory (MDI), and the Self-Compassion Scale (SCS). A 2 × 3 repeated measures analysis of variance (ANOVA) showed gains for the intervention-group in personal growth self-efficacy and healthy impulse-control and reductions in self-judgment and habitual negative self-directed thinking, as well as increases in self-compassion and reductions in anxiety and depression. After all participants had completed the course, the groups were combined and repeated measures ANOVAs showed that changes remained at six-month follow-up for personal growth self-efficacy, self-judgment and habitual negative self-directed thinking; as well as for self-compassion, anxiety and depression. Concluding, a short self-compassion course seems an effective method of increasing self-compassion and perceived control over one's life for university students, as well as increasing mental health.

High prevalence and long-lasting implications of human-inflicted trauma call for effective treatment approaches reaching clients in need of trauma-specific treatment. Numerous approaches exist, but often with limited empirical support. There is also a tendency toward segregating treatment approaches depending on type of exposure history and presenting symptoms. This might exclude clients in need of trauma-specific treatment; therefore, treatment approaches that can reach more heterogeneous groups of clients are needed. In this article, a group-based treatment approach adjusted to include clients with a wide range of trauma-related problems and traumatic experiences will be presented. A brief outline of the approach is presented, together with the theoretical and empirical background, to facilitate implementation by practitioners and empirical testing.

The study explored how former trauma clients experienced the inclusion of skill training in their treatment, their ways of relating to and using these skills, and how this changed over time.Semi-structured qualitative in-depth interviews were conducted with 13 clients within three months of their completion of treatment, and again 11-13 months later.Analysis of the material resulted in three main themes: (1) Being ready to find new ways to deal with trauma-related problems as a motivational starting point at intake, (2) Finding new agency through skills and understanding, and (3) One year on-Meeting the everyday world in a new way. An overreaching theme was the significant effort clients put into their treatments.The results show how skills over time became integrated and were linked to profound changes, including changes in emotional processing and an increased sense of agency. An experiential interrelationship between understanding and action was found, that supports the practice of coupling skill training with psychoeducation in trauma-specific treatment.

Psychotherapy researchers are increasingly using qualitative approaches to gain knowledge about the experiential, relational, and sociocultural aspects of psychological treatments. In this article, we explore and discuss five core functions of qualitative approaches within this field. They include: (a) a discovery function—to fill in knowledge gaps and challenge our pre-assumptions; (b) a reflexive function—to make ourselves more conscious about our prejudices and basic assumptions on personal, theoretical, and ideological levels; (c) a critical function—to address contextual issues of political and social injustice; (d) an emotional receptive function—to offer an emphatic listening perspective that facilitates the exploration of the emotional realities of psychotherapy; and (e) an evocative and aesthetic function—to communicate the experiential realities of psychological treatments that bring these realities to life while also providing a deeper understanding. publishedVersion

As the number of migrants,- forced or voluntary,- increases, there is a growing need to understand how negative events in the country of origin influence those residing abroad. This issue has been actualized by the recent earthquakes in Haiti and Chile. Persons in exile have frequently been exposed to severe human rights violations and other stressors prior to emigration. The present study explored possible associations between ongoing and former stressors and mental health problems among persons living in exile as the Tsunami disaster of 2004 struck their country of origin. The contribution of former exposure and exilerelated difficulties in explaining current mental health problems was explored together with Tsunami related bereavement and social support. Following the Tsunami disaster of 2004 a questionnaire was administered to individuals of Tamil and Acehnese origin residing in Norway. The results suggest an independent contribution of exilerelated difficulties, former exposure and social support in explaining current mental health problems in this group. The study also disclosed methodological challenges involved both in relation to recruiting participants and in isolating the contribution of a particular stressor in populations with high levels of former exposure as well as ongoing stress.