“In my own comfort zone”: Clients' experiences of relational aspects of online therapy for alcohol problems

Background

Therapists and counsellors increasingly use online video applications to offer treatment in place of face-to-face delivery. In the alcohol treatment sector, this offers a range of potential benefits for treatment providers. However, the impact of working remotely via video on the therapeutic relationship remains unclear and under-researched.

Aims

This study aimed to explore how alcohol treatment clients make sense of the relational aspects of therapy delivered remotely, and to examine how the use of remote therapy might disrupt existing ideas around the therapeutic relationship.

Methodology

This study utilised a qualitative design using thematic analysis, with 15 participant interviews with adult service users from a single treatment provider. All participants had previously undertaken at least four 1-h online therapy sessions.

Findings

The themes that were identified highlighted the significance of the participants' own homes as the site of therapy, with emphasis on the comfort of the home, and the presence of family members and pets. Participants stressed the importance of viewing the face of the therapist, the establishment of a therapeutic bond and specific therapist qualities. Participants also reflected on issues around denial and avoidance associated with self-image and identity.

Discussion

There are nuanced and potentially unforeseen consequences of undertaking therapy for alcohol problems via video, relating to the significance of the therapy environment and relationship between client and therapist. This may include issues of shame, denial and avoidance, which are of particular significance for clients experiencing difficulties associated with alcohol.     

A plausible role of imagination in pretend play,counterfactual reasoning,and executive functions

A notable observation is the similarities in the cognitive processes of pretend play (PP) and counterfactual reasoning (CFR) as both involve thinking about alternatives to reality. It is argued by Weisberg and Gopnik (Cogn. Sci., 37, 2013, 1368) that alternative thinking in PP and CFR is underpinned by an imaginary representational capacity but few studies have empirically investigated this link. We use a variable latent modelling approach to test a hypothetical model of the structural relationship of PP and CFR predicting that if PP and CFR are cognitively similar; they should have similar patterns of associations with Executive Functions (EFs). Data were collected on PP, CFR, EFs and Language from 189 children (M = 4.8 years, males = 101, females = 88). Confirmatory factor analyses showed that measures of PP and CFR loaded onto single latent constructs and were significantly correlated (r = .51, p = .001) with each other. Hierarchical multiple regression analyses revealed that EF accounted for unique significant variance in both PP (β = 21) and CFR (β = 22). The results of the structural equation modelling revealed that the data were a good fit for the hypothetical model. We discuss the plausible role of a general underlying imaginative representational capacity to explain similarities in the cognitive mechanisms of different states of alternative thinking like PP and CFR.     

Cognitive load and person memory: the role of perceived group variability

Two studies investigated the effects of cognitive busyness and group variability on participants' memory for stereotype‐related information. In Study 1, participants formed an impression of an experimentally created group that was either homogeneous or heterogeneous in composition. While learning about the group, half of the participants were made cognitively busy, the others were not. The results supported our prediction that stereotypical efforts on memory are moderated by both the availability of processing resources and the variability of the target group under consideration. Under optimal processing circumstances, participants' recollections were dominated by the perceived variability of the group in question. That is, participants displayed preferential recall for stereotype‐consistent information when they believed the group to be homogeneous in composition, but a tendency to recall more stereotype‐inconsistent information when they considered the group to be heterogeneous in nature. Under sub‐optimal processing conditions, however, a different pattern emerged. Now, participants preferentially recalled stereotype‐consistent information regardless of the perceived variability of the group. These results were largely replicated in Study 2 when the perceived variability of a real social group was manipulated. We consider the implications of these findings for contemporary theories of stereotyping. Copyright © 1999 John Wiley & Sons, Ltd.     

When the mind is otherwise engaged: resource depletion and social stereotyping

This study investigated the effects of resource depletion on stereotyping. Participants were instructed to form an impression of a target, and whilst performing this task, they overheard a tape-recorded conversation. The conversation was manipulated so that it was more or less relevant to the participants. Results in general supported the prediction that when participants eavesdrop on a relevant conversation, attentional capacity will be diminished, and target evaluations will be stereotypic in implication. Findings are discussed in terms of contemporary treatments of stereotyping. © 1998 John Wiley & Sons, Ltd.     

The test-taking expectations scale: Psychometric properties and relations with test anxiety

The present research examined the psychometric properties of the Test-Taking Expectations Scale (TTES), an individual difference measure of unrealistic test-taking expectations. The present research also examined the relations among a revised measure and (a) Sarason's (1984) multi-component test-anxiety measure, (b) academic performance as indexed by actual course grades, and (c) verbal ability as indexed by scores on a vocabulary measure. Reliability and factor analyses employing initial and cross-validation samples revealed that four TTES items have low item-total correlations. The revised TTES, compared to the original measure, was found to be internally consistent, more factorially ‘pure’, and strongly correlated with test anxiety, particularly with tension and worry components. Although the revised TTES did not correlate significantly with measures of academic performance and vocabulary ability, regression analyses showed that the test anxiety and vocabulary measures did predict actual academic performance.     

Single Session Treatment of Test Anxiety with Eye Movement Desensitization and Reprocessing (EMDR)

One session of Eye Movement Desensitization and Reprocessing (EMDR) appeared to be an effective treatment for test anxiety, reducing reported physiological distress, worry, and fears of negative evaluation. The research design included two components: a comparison study, comparing Immediate Treatment and Wait List groups, and a replication study, comparing the treatment response of Immediate and Delayed (Treated Wait List) groups. Seventeen test anxious university students were randomly assigned to one session of EMDR or Wait List. At post-test, the Immediate group demonstrated significant improvement, compared to the Wait List group, on the Test Anxiety Inventory (TAI) and Fear of Negative Evaluation Scale. Treatment effects were maintained at follow-up. The Wait List group received treatment after post-measures were taken. Treatment of the Delayed group replicated effects. Improvement was reflected by large treatment effect sizes and a decrease in percentile ranking on the TAI from the 90th to the 50th percentile.     

Investigating whether controlling and aggressive relationship behaviors are discriminant

Control is theorized as central to intimate partner aggression (IPA). Tools measuring nonphysical “controlling behaviors” in relationships have therefore been developed to identify the latent construct of control. However, the underlying assumption that “controlling behaviors” form a distinct subset of IPA has not been validated. This study investigates the divergent validity of acts considered as “controlling behaviors” against other aggressive acts used in relationships. The IPA and relationship literatures were reviewed to identify 1,397 items involving “controlling,” physical, sexual, and psychologically aggressive acts perpetrated and/or experienced by an intimate partner. In total, 101 item pairs were identified and used to measure IPA tactics across these categories. In Study 1, exploratory factor analysis in a community sample (N = 561) found no evidence of a distinct factor of “controlling behaviors.” Behaviors labeled as “controlling” in existing measures were distributed across other factors, including “eclectic aggression,” “direct psychological aggression,” and “monitoring acts.” In Study 2A (N = 424 students), confirmatory factor analysis replicated the results of Study 1 and established configural measurement invariance (Study 2B), indicating no evidence for psychometric differences between samples. These results indicate that behaviors described as “controlling” in existing measures were not statistically distinguishable from other forms of IPA, and suggest that future research should investigate motivational, rather than behavioral, differences in the use of IPA. The findings challenge research to confirm whether a set of discrete behaviors can be used to accurately identify control in relationships and question the validity of tools that adopt this methodology.     

War,revolution, and psychoanalysis: Freudian thought begins to grapple with social reality

Psychoanalytic theory and practice have been affected by external events as well as by internal development. Specifically, the period of the Great War and its aftermath was a turning point in the history of psychoanalysis. These experiences emphasized the inadequacy of the libido theory alone, accelerated Freud's impetus toward metapsychology, and encouraged the articulation of theories of innate destructive urges, of ego instincts, of the superego, and of social interaction. Discussionsof war neuroses, of aggression and the death instinct, of the reality principle, and of the mechanisms of social psychology undermined Freud's original biologism in favor of a social-scientific approach. Psychoanalytic theory began to take more account of social experience and was profoundly changed in the process.