An International Survey of the Concept of Effective Psychodynamic Treatment During the Pandemic

Introduction: Most psychotherapists had no choice during the COVID-19 pandemic but to offer teletherapy in order to provide needed treatment. Several psychoanalytic theorists wondered if the very concept of treatment would change without an embodied relationship in an office setting. Methods: To attempt to understand the current concept of effective psychodynamic treatment in the new norm of teletherapy, we surveyed practitioners from 56 countries and regions who remotely treated patients psychodynamically during the beginning months of the pandemic. We asked the practitioners to rank six factors felt to be important to psychodynamic treatment: use of the couch during sessions, session in-office or via teletherapy, cultural similarity between therapist and patient, number of sessions a week, patient factors (motivation, insightfulness, and high functioning) and therapist factors (empathy, warmth, wisdom, and skillfulness). Results: We received 1,490 survey responses. As predicted, we found that the therapist and patient variables were considered much more important (both tied as highest rankings) to effective treatment than any of the other variables, including if the therapy was in-office or by teletherapy. Discussion: Psychodynamic practitioners worldwide confirmed that the empathy, warmth, wisdom, and skillfulness of the therapist and the motivation, insightfulness, and level of functioning of the patient are most important to treatment effectiveness regardless if the treatment is remote or embodied.

The Relational Fit in Organizational Interventions—What Can Organizational Research Learn from Research in Psychotherapy?

There is a growing interest in organizational interventions (OI) aiming to increase employees’ well-being. An OI involves changes in the way work is designed, organized, and managed. Studies have shown that an OI’s positive results are increased if there is a good fit between context and intervention and between participant and intervention. In this article, we propose that a third fit—the Relational Fit (R-Fit)—also plays an important role in determining an intervention’s outcome. The R-Fit consists of factors related to 1) the employees participating in the OI, 2) the intervention facilitator, and 3) the quality of the relation between participants and the intervention facilitator. The concept of the R-Fit is inspired by research in psychotherapy documenting that participant factors, therapist factors, and the quality of the relations explain 40% of the effect of an intervention. We call attention to the importance of systematically evaluating and improving the R-Fit in OIs. This is important to enhance the positive outcomes in OIs and thereby increase both the well-being and productivity of employees. We introduce concrete measures that can be used to study and evaluate the R-Fit. This article is the first to combine knowledge from research in psychotherapy with research on OIs.

The Engaged Child in Occupational Therapy

Background. Achieving optimal outcomes for children in occupational therapy settings is influenced, in part, by their engagement. The nature of child engagement from the occupational therapy perspective remains relatively unexplored. Method. A qualitative research methodology was adopted, using an interpretive description approach. Thirty-two occupational therapists participated in five focus groups and six individual interviews that were thematically analyzed. Findings. Four themes emerged from the data: (i) signs of child engagement and disengagement; (ii) it’s about the child feeling safe; (iii) a sense of meaning and purpose; and (iv) service and therapist factors influencing child engagement. Implications. Helping the child feel safe; providing meaningful experiences; and being flexible and responsive were key means of connecting with, and supporting, child engagement. Strategies occupational therapists reportedly used to engage the child aligned with the tenets of self-determination theory (autonomy, relatedness, and competence).

Psychotherapy with clients with addiction(s): a grounded theory study of effective therapeutic approaches

Background: addiction is a multifaceted topic with social, cultural, and political undertones and influences. It can be considered challenging to work with psychotherapeutically. Aim: to counter this pejorative conjecture, this study aimed to explore the approaches experienced therapists use in their clinical work. Methodology: to investigate what has proved important and therapeutically helpful empirically, ten qualitative semi-structured interviews were carried out with experienced clinicians of varying modalities working with addiction. Transcripts were analysed using constructivist grounded theory. Findings: one core category emerged from the data: what was revealed to be effective in working with addictions is a unique, contextualised, collaborative and creative therapeutic approach. Five sub-categories transpired: 1) contextual factors; 2) therapist factors; 3) client factors; 4) conceptualisations; 5) therapeutic work. The findings indicate that through engagement with unique psychosocial understandings of clients, therapists enhance their own understandings of the phenomenon of addiction, which then informs their therapeutic approach. It is argued that an individualised and creative approach, anchored in the particular needs, personal preferences or beliefs of the client, is given preference over rigid adherence to any particular therapeutic model.

Balancing clinical risk with countertransference management protects alliance

The working alliance has been recognized as a predictor of psychotherapy outcome across therapeutic orientations. Despite mixed findings regarding the effect of problem severity on the alliance formation, there is evidence suggesting that therapist factors may interfere in this association. This study examined how clients baseline clinical features affected the early alliance and the possible role of therapists countertransference management as a mediator. Thirteen therapeutic dyads were assessed at 2 different time points. Clients clinical dimensions were assessed prior to the 2nd session, and therapists countertransference management and clients ratings of the alliance were measured after the 2nd session. Positive associations were found between clients subjective wellbeing, social functioning, risk, and global psychological distress and countertransference management dimensions and total score. Empathy-based countertransference management suppressed the negative impact of clinical risk on alliance. Our findings suggest that clinical problems activate countertransference management, which in turn may buffer their negative effect on alliance.