Therapeutic alliance in a cognitive rehabilitation programme for people with serious mental illness: A qualitative analysis

Faith, Laura A.; Howie, Judith; Blanco, Emily; Jarvis, Stephen; Rempfer, Melisa

doi:10.1111/papt.12412

Cited by 4 publications

(2 citation statements)

References 61 publications

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“…Regarding similarities between the two groups of clinicians, not surprisingly we found that both groups focused on the therapeutic relationship and monitoring progress. Therapeutic alliance has long been recognized as an important element of recovery-oriented care for persons with psychosis, is associated with recovery outcomes, 11 , 35 , 36 and is recognized by clinicians from qualitative interviews as an important element of psychiatric rehabilitation. 13 , 14 , 23 Although the groups both valued the relationship, they were described differently.…”

Section: Discussionmentioning

confidence: 99%

Promoting Meaning and Recovery for Psychosis: Comparison of Metacognitively-Oriented Psychotherapists and Clinicians in Psychiatric Rehabilitation

Faith,

Wiesepape,

Kukla

et al. 2023

NDT

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Introduction Recovery from psychosis is an expected and desired outcome in psychiatric rehabilitation that may involve subjective outcomes related to personal recovery. While a considerable amount of qualitative research has examined patients’ experience of recovery oriented approaches, there are less studies examining clinicians’ perspectives. Examining the clinician point of view is important for both supporting clinicians within recovery-oriented practice, as well as for understanding underlying therapeutic processes. The aims of this study were to explore clinician experience of offering different psychiatric rehabilitation treatments for individuals with psychosis, and to understand similarities and differences of clinicians whose work differed in its recovery emphasis. Methods Open-ended interviews were conducted with 10 psychotherapists providing Metacognitive Reflection and Insight Therapy (MERIT), a recovery oriented form of integrative psychotherapy focused on subjective aspects of recovery, and 10 clinicians providing standard psychiatric rehabilitation services. Results Thematic analysis revealed important similarities and differences between these two groups of providers. There were seven themes found for MERIT therapists: Comfort with uncertainty, Emphasis on collaboration, Being part of therapeutic change, Connecting with clients, Emphasis on patient autonomy, Experiencing growth, and Therapist use of self-awareness. There were four themes found for psychiatric rehabilitation clinicians: Value of a structured approach, Focus on a strengths-based approach, Witnessing behavioral change, and Building rapport to support the work. Discussion As expected, both similarities and differences arose between clinician groups. Results indicated that both groups focused on the therapeutic relationship and monitoring progress and outcomes. Unexpectedly, MERIT therapists reported growth as well as comfort with uncertainty. These findings suggest that MERIT is a a psychotherapy that offers unique opportunities for creative and flexible exploration of meaning and agency that is both challenging and rewarding for clinicians. Implications for supporting healthy clinician practice and the development of services are discussed.

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Section: Discussionmentioning

confidence: 99%

Promoting Meaning and Recovery for Psychosis: Comparison of Metacognitively-Oriented Psychotherapists and Clinicians in Psychiatric Rehabilitation

Faith,

Wiesepape,

Kukla

et al. 2023

NDT

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“…In addition, video sessions realized new rapport-building opportunities encouraging an equal stance for joint reflection in which therapist and client existed in their personal physical spaces, buttressed by shared interests and common human experiences related to the pandemic. This virtual environment afforded the opportunity for the therapist to build rapport through genuineness and authenticity, an important element of the therapeutic alliance (Faith et al, 2022;Schnellbacher & Leijssen 2009). In the case of George, he declined video sessions, so therapy began over the telephone.…”

Section: Conflict Of Interestmentioning

confidence: 99%

Metacognitive Reflection and Insight Therapy (MERIT) Delivered Virtually During the COVID-19 Pandemic: An Illustration of Two Cases

Faith

Chung-Zou

Kukla

2022

J Contemp Psychother

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Alternative platform offerings for psychotherapy have become a necessity in the age of the novel coronavirus (COVID-19) pandemic. The current study describes the virtual adaptation of Metacognitive Reflection and Insight Therapy (MERIT) for people with psychosis. MERIT is a recovery-oriented psychotherapy that has shown promise in increasing metacognition and allowing individuals to make meaning of their psychiatric challenges and direct their own recovery efforts. MERIT delivery requires the assumption that metacognitive reflection is an intersubjective act where individuals make meaning with others instead of in isolation. As such, considering the current COVID-19 pandemic, research is needed to understand how intersubjectivity and the therapeutic alliance may differ in a virtual environment rather than in-person. The present study addresses this question by illustrating two case examples of MERIT’s adaptation to a virtual delivery telehealth format. Moreover, this study expands on Lysaker and colleagues’ (2020) investigation of virtual adaptations of MERIT by exploring how MERIT is adapted in a virtual environment, how intersubjectivity changes in a virtual environment, and, what opportunities virtual platforms allow for metacognitive reflection. Overall, we found that MERIT can be successfully delivered in a virtual telehealth platform. We discuss opportunities and considerations for MERIT and other psychotherapy virtual delivery.

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Service User Representation in Qualitative Research on Cognitive Health and Related Interventions for Psychosis: A Scoping Review

Gonzales,

Jones

2024

Schizophrenia Bulletin

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Background and Hypothesis Cognitive health in schizophrenia spectrum psychosis has received substantial empirical attention in recent decades, coinciding with the development and implementation of interventions including cognitive remediation. Subjective experience in psychosis, including qualitative explorations of service user perspectives, has also proliferated; however, there is no available synthesis of service user representation in the psychosis cognitive health literature. This scoping review investigated prevalence and characteristics of qualitative research reporting service user perspectives across the extant research on cognitive health and related interventions in psychosis. Study Design We conducted a literature search on qualitative methods in cognitive health and/or related interventions across PubMed, Web of Science, and PsycInfo databases. The review followed the PRISMA-ScR guidelines for scoping reviews and identified 23 papers. Data extraction included study design and sample characteristics, qualitative methodology, and reporting. Study Results Of 23 articles, 18 reported on user experiences of interventions, most often in the context of feasibility/acceptability for otherwise quantitative trials. Five studies described service user experiences of cognitive health separately from interventions. Only 3 included any service user involvement or participatory methods. Twenty articles reported any demographic characteristics, and fewer than half (11) reported any racial or ethnic sample characteristics. There was substantial variability in qualitative methodology and reporting across studies. Conclusions Qualitative methodology is lacking in its representation and rigor across the cognitive health literature for schizophrenia spectrum psychosis. Additional inclusion of service user lived experience is critical for future research to better characterize cognitive health and inform interventions to promote recovery.

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Therapeutic alliance in a cognitive rehabilitation programme for people with serious mental illness: A qualitative analysis

Cited by 4 publications

References 61 publications

Promoting Meaning and Recovery for Psychosis: Comparison of Metacognitively-Oriented Psychotherapists and Clinicians in Psychiatric Rehabilitation

Promoting Meaning and Recovery for Psychosis: Comparison of Metacognitively-Oriented Psychotherapists and Clinicians in Psychiatric Rehabilitation

Metacognitive Reflection and Insight Therapy (MERIT) Delivered Virtually During the COVID-19 Pandemic: An Illustration of Two Cases

Service User Representation in Qualitative Research on Cognitive Health and Related Interventions for Psychosis: A Scoping Review

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