Changes in verbalizations during sandplay: an empirical study

This is a quantitative study of an 11-year-old boy diagnosed with major depression who in all but one session made a sandplay. A computerized system was used to analyse the written verbalizations on four dimensions of positive and negative: emotions, contracts (psychosocial agreements, relationships, etc.), performance (behaviour) and rewards. It was hypothesized that the verbalizations made by the patient (recorded by the therapist) would become more positive and less negative during the course of therapy. The positive and negative values of the four dimensions were correlated with the session number. This was supported on two (performance & contract) of the four positive dimensions (statistically significant). The hypothesis that the negative dimensions would become less negative was supported on all four dimensions (statistically significant). Thus, six of the eight hypotheses were supported. This uninvestigated area of research illustrates verbal interactions between patient and therapist were an important aspect of sandplay therapy. Through reanalysing the sessions for quantitative content, written recording of direct quotes and observation of behaviour, data was entered into a valid and reliable coding system to quantitatively analyze the verbalizations. This analysis of verbalizations of the patient and observations made by the therapist indicates sandplay therapy is multifaceted.     

Creative Occupational Therapist: It's About the Client Using Focus Groups to Explore Creativity in Occupational Therapy

Although creativity is an important aspect of occupational therapy theory and practice, there have been few studies that would explore this concept in the context of the occupational therapy process. This was the first qualitative study of creativity in occupational therapy in Slovenia. It was conducted as part of a larger mixed-methods study and included 22 experienced occupational therapists who participated in four focus groups. The focus of the study was on the exploration of different factors that could contribute to creativity and creative strategies in occupational therapy, in either a positive or a negative way. Since occupational therapy promotes a client-centered therapy approach, the role of the client as the motivating factor was of particular interest to our study. Six factors that can influence the creativity of occupational therapists emerged from the qualitative analysis (Strauss & Corbin, 1990). While the client was identified as the key factor, the potential of other factors was also recognized. This qualitative study increased the understanding of the concept of creativity and creative behavior in occupational therapy, and also provided empirical material that formed the basis for the development of a questionnaire on creativity in occupational therapy.     

Thoughts on representation in therapy of Holocaust survivors1

This paper presents the problems of representation and lack of representation in treating Holocaust survivors, through clinical vignettes and various theoreticians. The years of Nazi persecution and murder brought about a destruction of symbolization and turning inner and external reality into the Thing itself, the concrete, or, in Lacan’s words, ‘The Thing’. The paper presents two ideas related to praxis as well as theory in treating Holocaust survivors: the first is related to the therapist’s treatment of the Holocaust nightmare expressing the traumatic events just as they happened 63 years previously; the second deals with the attempt at subjectification, in contrast to the objectification forced by the Nazis on their victims.     

Self-Acceptance Group Therapy: A Transdiagnostic,Cognitive-Behavioral Treatment for Shame

Shame has broad importance to psychological problems. However, few interventions specifically address shame, and most of these have been designed to target shame in the context of particular disorders. Self-Acceptance Group Therapy (SAGT) was developed as a transdiagnostic shame-focused treatment, based on a cognitive-behavioral framework. SAGT is an 8-week treatment that involves psychoeducation and training in the use of cognitive and behavioral shame regulation and support-building skills in order to promote self-acceptance. After describing SAGT, the study presented used an open trial design to examine the utility of SAGT for addressing shame, self-acceptance, quality of life, and relevant psychological problems (e.g., depression, social anxiety). Twenty-four outpatients with elevated shame were assessed at pretreatment, posttreatment, and 1-month follow-up. By post-treatment, results revealed significant improvements in self-acceptance, shame, and borderline personality disorder (BPD) symptoms among treatment completers (n = 18), with all of these improvements maintained at follow-up. Additionally, significant improvements in quality of life, emotion dysregulation, depression, loneliness, and stress were observed at follow-up. Results provide preliminary support for SAGT’s utility in the treatment of shame and related pathology among diverse outpatients.     

Development and Pilot Evaluation of Smartphone-Delivered Cognitive Behavior Therapy Strategies for Mood- and Anxiety-Related Problems: MoodMission

Given the ubiquity and interactive power of smartphones, there are opportunities to develop smartphone applications (apps) that provide novel, highly accessible mental health supports. This paper details the development of a smartphone app, “MoodMission,” that aims to provide evidence-based Cognitive Behavior Therapy (CBT) strategies for mood- and anxiety-related problems, contributing to the prevention of clinically significant depression and anxiety disorders and serving as an adjunct to therapeutic interventions delivered by trained health professionals. MoodMission was designed to deliver strategies in the form of real-time, momentary responses to user-reported low moods and anxiety. The development process involved: (a) construction of a battery of strategies, (b) empirical evaluation, (c) a software and behavioral plan design and testing process, (d) user feedback, and (e) a public launch. A pilot study of 44 participants completed the Mobile Application Rating Scale (MARS; Hides et al., 2014) for usability testing and feedback. MoodMission was rated significantly higher than standardized health app norms on the majority of the domains, including Entertainment, Interest, Customization, Target Group, Graphics, Visual Appeal, Quality of Information, Quantity of Information, Visual Information, Credibility of Source, Recommendation to Use, Estimated Frequency of Use, and Overall Rating (Hedges’s g range 0.57–1.97, p < .006). Case examples illustrate the practical uses of the app. In addition to clinical applications, MoodMission holds promise as a research tool either as an augmentation to clinician-delivered therapy, or as a vehicle for standardizing client access to specific CBT strategies (e.g., in studies intending to study different change processes).     

Topic-focused analysis in a case of integrative psychotherapy with a father fearing his own anger

Even though evidence-based knowledge is considered the foundation of clinical practice, many clinicians question the clinical relevance of published research. Clinicians increasingly define themselves as having an integrative stance, in contrast to the tendency for most research to be based on clearly defined psychotherapies. Qualitative single case studies make it possible to generate knowledge about what actually occurs in integrative therapy. Topic change process analysis (TCPA) is used in the analysis of brief integrative therapy conducted by a very experienced psychotherapist drawing on a complex variety of therapeutic approaches. The client was a man in his late thirties, worrying about his strong anger, particularly related to one of his children. Analysis of topic areas, topic shifts, response patterns within topics and changes in perspective made it possible to identify key processes and key patterns of the therapy which resulted in a very positive outcome for the client. Implications of these findings for practice, and future research, are discussed.     

Striving Towards Empowerment and Medication Adherence (STEP-AD): A Tailored Cognitive Behavioral Treatment Approach for Black Women Living With HIV

In the U.S. Black women with HIV face numerous psychosocial challenges, particularly trauma, racism, HIV-related discrimination, and gender role expectations, that are associated with negative HIV health outcomes and low medical treatment adherence. Yet many of these factors are unaddressed in traditional cognitive behavioral approaches. This study presents a case series of a tailored cognitive behavioral treatment approach for Black women living with HIV. Striving Towards EmPowerment and Medication Adherence (STEP-AD) is a 10-session treatment aimed at improving medication adherence for Black women with HIV by combining established cognitive behavioral strategies for trauma symptom reduction, strategies for coping with race- and HIV-related discrimination, gender empowerment, problem-solving techniques for medication adherence, and resilient coping. A case series study of five Black women with HIV was conducted to evaluate the preliminary acceptability and feasibility of the treatment and illustrate the approach. Findings support the potential promise of this treatment in helping to improve HIV medication adherence and decrease trauma symptoms. Areas for refinement in the treatment as well as structural barriers (e.g., housing) in the lives of the women that impacted their ability to fully benefit from the treatment are also noted.     

Staff and Administrators’ Perceptions of Music Therapy with Acute Care Mental Health Inpatients: A Qualitative Investigation

The purpose of this qualitative study is to understand staff members’ and administrators’ perceptions of group-based music therapy in an acute care mental health setting. The researcher conducted semi-structured interviews with six experienced administrators and unit staff who were familiar with music therapy. Using an inductive approach to thematic analysis, the author identified six themes: (a) music constitutes an important role in patients’ lives, (b) patient-centricity and competence of the music therapist, (c) music therapy uniquely engages the patient with music, the music therapist, and peers, (d) music therapy shifts patients’ focus from internal to external, (e) music therapy is a normalizing experience that facilitates interaction, and (f) music therapy provides optimal conditions for cognitive, affective, and behavioral change. Implications for clinical practice, suggestions for future research, and limitations of the study are provided.