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Psychotherapeutic skills are essential elements in the daily work of psychiatrists. This article aims to bring attention to the psychotherapeutic competences described in the new training program for psychiatrists in the Netherlands. To illustrate the competences, two clinical cases are presented in which the psychiatrist executes psychotherapeutic skills to be effective in diagnosis and treatment. With the help of these psychotherapeutic competences, the psychiatrist manages to tolerate and understand frequently occurring demands of complex psychiatric patients, is able to make sense of behavior and, if possible, is able to reflect on this with the patient with the aim to start effective psychotherapeutic interventions and make progression in treatment. Clinical psychiatric practice cannot be seen apart from psychotherapy, because without psychotherapeutic knowledge and skills, treatment will be ineffective and can cause stagnating treatments, ineffective treatment relationships, overdiagnosis, regression in the patient or polypharmacy.

It is known that personality traits can disappear during recovery from depressive disorder. Three case descriptions show the opposite: depressive symptoms can disappear after psychotherapeutic treatment of the personality disorder. In the treatment of depression, early recognition and diagnosis of a comorbid personality disorder is essential for considering different treatment options.

[This corrects the article DOI: 10.1371/journal.pone.0206262.].

Objective: To explore which of 50 self-management strategies are actually used and which are perceived as most helpful by patients in their day-to-day management of depression, in order to empower patients and promote active engagement in their own care., Methods: Retrospective study using an online self-report survey to assess the use and perceived helpfulness of 50 previously identified self-management strategies in 193 participants who recently recovered from a major depressive episode., Results: Forty-five of the 50 strategies were used by at least half of all participants and about one third of all participants perceived almost 50% of all strategies as (very) helpful. The most used strategies, such as 'finding strategies to create pleasurable distractions', 'engaging in leisure activities' or 'identifying the cause of the depression', were not always perceived as most helpful. In addition, the perceived most helpful strategies, such as 'completing treatment' and 'leaving the house regularly' were not always the most used ones., Conclusions: Patients use and perceive a wide range of self-management strategies as helpful to recover from their depression. Patients use and perceive strategies about engagement in treatment and physical activities as being most helpful. These finding may contribute to the further development and implementation of self-management programs for the prevention or the rehabilitation of depression., Competing Interests: The authors have declared that no competing interests exist.

Background: More than two-thirds of all patients suffering from depression experience insufficient improvement despite treatment. Self-management strategies and treatment objectives should be more in line with what patients consider to be helpful. This would improve the treatment efficacy of domains relevant to patients and allow for self-management of depression where possible.
AIM: To explore the patient's perspective on self-management and professional treatment for depression.
METHOD: Predominantly qualitative methods: in-depth individual interviews, concept mapping (mixed method) and a nationwide self-report survey.
RESULTS: Participants generated 50 self-management strategies addressing themes such as engaging in activities (e.g. 'leaving the house regularly'), focus on the diagnosis depression (e.g. 'acceptation') and treatment (e.g. 'trusting the therapist'), remaining socially engaged (e.g. 'informing family about the depression') and good structure and self-care (e.g. 'setting realistic goals'). A lack of clarity and consensus about either the nature of the depression or the content of treatment and a precarious relationship with the professional were perceived as impeding characteristics of treatment.
CONCLUSION: Patients appear to be able to contribute actively and in various ways when managing their own mental health. By exploring the patient's perspectives, professionals could offer treatment established through shared goals.

Objective: Depression research has resulted in knowledge about neurobiology, pharmacological strategies and short-term cost-effective treatments. However, more than two-thirds of all depressed patients experience insufficient improvement. Therefore, a better understanding of what patients, carers and professionals perceive as most helpful in the treatment of depression is needed., Methods: Concept mapping, a mixed-method design, was used to identify the patients (n = 33), carers (n = 22) and professionals (n = 50) perspectives. In six brainstorm sessions, the patients, carers and professionals generated 795 ideas, which were condensed into 55 unique statements. Subsequently, 100 participants prioritized and sorted these statements, which were analysed by multidimensional scaling and cluster analysis and visualized as a two-dimensional map., Results: The 55 statements were clustered in 10 factors and further grouped into four main-factors (meta-clusters): 'Professional therapist', 'Treatment content', 'Structured treatment process' and 'Treatment organisation'. Patients and carers prioritized 'Treatment organisation' higher than professionals, but overall there was considerable agreement about the factors of treatment the participants perceived as most helpful including factors related to the therapeutic relationship and the 'creation of hope'., Conclusions: Our study identified factors of depression treatment perceived as helpful according to patients, carers and professionals. Findings suggest that in a scientific era with emphasis on biological psychiatry, not only patients and carers, but also professionals consider aspecific factors the most helpful. Further studies might show that factors we found to be helpful in the treatment for depression, can be generalized to mental health treatment in general., Competing Interests: The authors have declared that no competing interests exist.

Background: Self-management appears to be a promising approach in the case of depression, which helps to stimulate patients' autonomy. However, a good and systematic description of the concept self-management from the patients' perspective, to our knowledge, has not yet been performed., Objective: To determine: (i) what strategies patients think they can use themselves to recover from depression, (ii) which main themes of self-management strategies can be detected, and (iii) which of these strategies patients perceive as being most helpful., Methods: We used concept mapping to explore the experiences of patients who recently recovered from a depressive episode. Patients generated self-management strategies in focus group discussions. The strategies were clustered on a two-dimensional concept map by a hierarchical cluster analysis., Results: Patients generated 50 strategies that formed eight clusters: (i) proactive attitude towards depression and treatment, (ii) daily life strategies and rules, (iii) explanation of disease to others, (iv) remaining socially engaged, (v) engaging in activities, (vi) structured attention to oneself, (vii) contact with fellow sufferers, and (viii) other. Behavioural and cognitive strategies and a proactive attitude towards treatment were considered as the most helpful., Discussion and Conclusion: From the patients' perspective, there is a wide range of self-management strategies that they can use - and perceive as helpful- to contribute to their own recovery. Professionals could encourage patients to take an active role in achieving recovery. Further research could open new roads to improve patients' active contributions to current treatments for depression., (© 2013 John Wiley & Sons Ltd.)

Background: Despite the development of various self-management programmes that attempt to ameliorate symptoms of patients with chronic major depressive disorder (MDD), little is known about what these patients perceive as helpful in their struggle during daily live. The present study aims to explore what patients believe they can do themselves to cope with enduring MDD besides professional treatment, and which self-management strategies patients perceive as being most helpful to cope with their MDD., Methods: We used concept mapping, a method specifically designed for the conceptualisation of a specific subject, in this case patients' point of view (n = 25) on helpful self-management strategies in their coping with enduring MDD. A purposive sample of participants was invited at the Academic Medical Center and through requests on several MDD-patient websites in the Netherlands. Participants generated strategies in focus group discussions which were successively clustered on a two-dimensional concept map by hierarchical cluster analysis., Results: Fifty strategies were perceived as helpful. They were combined into three meta-clusters each comprising two clusters: A focus on the depression (sub clusters: Being aware that my depression needs active coping and Active coping with professional treatment); An active lifestyle (sub clusters: Active self-care, structure and planning and Free time activities) and Participation in everyday social life (sub clusters: Social engagement and Work-related activities)., Conclusions: MDD patients believe they can use various strategies to cope with enduring MDD in daily life. Although current developments in e-health occur, patients emphasise on face-to-face treatments and long-term relations, being engaged in social and working life, and involving their family, friends, colleagues and clinicians in their disease management. Our findings may help clinicians to improve their knowledge about what patients consider beneficial to cope with enduring MDD and to incorporate these suggested self-management strategies in their treatments.

Background: More than 50% of all major depressive disorder (MDD) patients experience insufficient improvement from the available treatment options. There is emerging evidence that patients׳ beliefs and experiences about MDD treatment influence treatment outcomes. The aim was to explore patients׳ perspectives on impeding characteristics of professional treatment for the recovery of MDD., Methods: In-depth interviews in a purposive sample with 27 recovered MDD patients who had received professional treatment. Data were qualitatively analyzed using constant comparison., Results: Participants׳ accounts yielded four major impeding themes: lack of clarity and consensus about the nature of the participants׳ MDD and the content of their treatment; precarious relationship with the clinician; unavailability of mental health care; and insufficient involvement of significant others., Limitations: The external generalizability may be limited due to missed other subgroups within depression., Conclusions: This study identified a comprehensive overview of impeding characteristics in MDD treatment from patients׳ perspectives. This may help clinicians to understand how patients experience MDD treatment, and to incorporate patients׳ perspectives about treatment into their joint decision-making. This can lead towards increased treatment adherence, motivation and finally success., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objective: To investigate what patients themselves think they can contribute to recovery from depression, and what they find to be effective. The patients' perspective is necessary to improve treatment for depression., Design: Qualitative, hypothesis-generating study., Method: The experiences and opinions of 20 patients who had recently recovered from a depressive episode were investigated using the 'concept mapping' method. In the first stage, patients generated statements during group discussions around the question: 'What can people themselves do to recover from depression?' In the second stage, patients individually graded the statements by relevance and grouped them by common characteristics. In the third stage, the statements were analysed and positioned in a concept map., Results: In the first stage, the patients generated 50 statements which could be grouped into the following 8 clusters: active attitude towards depression and the assistance offered, regimen, explanation of the disease to acquaintances, social contacts, undertaking activities, structured attention for yourself, contact with fellow sufferers, and others. The common factor in statements that patients found the most important was that the focus for recovery should be on oneself., Conclusion: From the patients' perspective several methods were mentioned by which patients can contribute to their own recovery from depression. Practitioners could use these in their contact with the patient during treatment. This study also provides the basis for developing a self-management module for recovery from depression.

Objective: In patients with a chronic asymptomatic HIV-1 infection and >200 CD4+ T-cells/microl, the optimal timing of highly active antiretroviral therapy (HAART) initiation is unclear. It involves a trade-off between a potentially reduced risk of mortality, when started earlier in the course of infection, and an earlier exposure to pill burden and potential toxicities. We investigated patients' preferences for immediate HAART initiation relative to delaying HAART for 1 year., Methods: Consecutive patients were asked for their preference during an interview. A hypothetical difference in 3-year mortality risk between both options was systematically varied between 0% and 10% to determine the threshold at which preference would switch to HAART initiation., Results: About 30% of patients preferred HAART initiation even if the mortality risk would be equal for both options. Almost 25% always preferred delaying HAART even if this would result in a 10% greater mortality risk. Most treatment guidelines recommend delaying HAART >350 CD4+ T-cells/microl. However, at a risk difference between starting and delaying HAART that corresponds with this CD4+ T-cell count, about 50% would prefer to start HAART immediately. Most guidelines recommend starting HAART below 200 CD4+ T-cells/microl. However, at a risk difference between both options corresponding with this CD4+ T-cell count, about 40% preferred delaying HAART., Conclusions: We found large variation in patients' preferences. Some patients were more inclined to initiate HAART earlier than the recommended guidelines, whereas others were more inclined to delay HAART. These findings emphasize the need for shared decision-making when deciding on the most optimal timing of HAART initiation in chronic asymptomatic HIV-1 infection.