We especially thank Danaher and Tyler for their work in adapting the program to fit the requirements of our VA trial and for providing support/training.
Transgender, gender nonconforming, and nonbinary (TGNC/NB) individuals face higher rates of discrimination and violence than cisgender people, and as a result, experience higher rates of serious mental health concerns and isolation. Challenges with accessing affirming, competent psychological services are well documented. Group therapy could be one solution to some of these barriers; however, there is a lack of research examining group therapy for this population. Additionally, there is a paucity of community-based and qualitative research designs thus rendering TGNC/NB voices virtually silent. This community-based participatory approach used a semistructured focus group format and phenomenological thematic analysis to explore what TGNC/NB community members would like to see implemented in group therapy and group therapy research. Results offer guidance for practitioners of group therapy, considerations for group process, and group therapy research suggestions that will help maximize justice for the TGNC/NB community.
BACKGROUND Internet-delivered psychological interventions (IPIs) have been shown to be effective for a variety of psychological concerns, including postpartum depression. Human-supported programs produce better adherence and larger effect sizes than unsupported programs; however, what it is about support that affects outcomes is not well understood. Therapeutic alliance is one possibility that has been found to contribute to outcomes; however, the specific mechanism is not well understood. Participant perspectives and qualitative methodology are nearly absent from the IPI alliance research and may help provide new directions. OBJECTIVE In this study, we aimed to provide participant perspectives on engagement with an IPI for postpartum depression to help inform alliance research, development of new IPIs, and inform resource allocation. METHODS A qualitative methodology was used to explore participant perspectives of veteran women’s engagement with the MomMoodBooster program, a human-supported internet-delivered intervention for postpartum depression. Participants were asked 4 open-ended questions with the 3-month postintervention survey, “In what ways did you find the MomMoodBooster most helpful?” “How do you think the MomMoodBooster could have been improved?” “In what ways did you find the personal coach calls to be helpful?” and “How do you think the personal coach calls could have been improved?” RESULTS Data were collected from 184 participants who responded to at least 1 of the open-ended questions. These were analyzed using thematic analysis and a process of reaching a consensus among coders. The results suggest that not only the engagement with the support person is perceived as a significant contributor to participant experiences while using the MomMoodBooster content but also the relationship factors are particularly meaningful. The results provide insights into the specific qualities of the support person that were perceived as most impactful, such as warmth, empathy and genuineness, and feeling normalized and supported. In addition, the results provide insight into the specific change processes that can be targeted through support interactions, such as encouraging self-reflection and self-care and challenging negative thinking. CONCLUSIONS These data emphasize the importance of relationship factors between support persons and an IPI program for postpartum depression. The findings suggest that focusing on specific aspects of the alliance and the therapeutic relationship could yield fruitful directions for the training of support personnel and for future alliance-based research of internet-delivered treatments. CLINICALTRIAL
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