Hanne Weie Oddli

Strategies used by experienced therapists to explore client goals in early sessions of psychotherapy

The purpose of this study was to investigate the strategies used by highly experienced psychotherapists to explore client goals for psychotherapy during the first three sessions in treatments as usual. Transcripts from audio recordings of the initial three sessions of a sample of nine experienced therapists were analyzed using a modified constructivist grounded theory methodology. The transcripts revealed few therapist behaviors directed toward agreeing upon explicitly defined goals. Analysis of the data made it possible to identify two categories of goal-oriented activity: (1) ensuring that what happens in therapy is meaningful for the client and relevant to the attainment of the client’s goals; and (2) being aware of complexity – the client’s ambivalence and resistance to change. It is argued that the client–therapist dialogs examined in this study were characterized by processes regarding hope, motivation, and engagement rather than by explicit goal agreement. Implications for the concept of goal consensus and the working alliance are discussed.

Therapist strategies early in therapy associated with good or poor outcomes among clients with low proactive agency

Abstract Objective: Within a mixed methods program of research the present study aimed at expanding knowledge about interactions in the initial therapeutic collaboration by combining focus on client interpersonal style and therapist contribution. Method: The study involves in-depth analyses of therapist–client interactions in the initial two sessions of good and poor outcome therapies. Based on interpersonal theory and previous research, the Inventory of Interpersonal Problems (IIP-64-C) was used to define poor outcome cases, that is, low proactive agency cases. To compare good and poor outcome cases matched on this interpersonal pattern, cases were drawn from two different samples; nine poor outcome cases from a large multi-site outpatient clinic study and nine good outcome cases from a process-outcome study of highly experienced therapists. Results: Qualitative analysis of therapist behaviors resulted in 2 main categories, fostering client’s proactive agentic involvement in change work and discouraging client’s proactive agentic involvement in change work, 8 categories and 22 sub-categories. Conclusion: The findings revealed distinct and cohesive differences in therapist behaviors between the two outcome groups, and point to the particular therapist role of fostering client agency through engagement in a shared work on change when clients display strong unassertiveness and low readiness for change. Clinical or Methodological Significance Summary: The present analysis combines focus on client interpersonal style, therapist strategies/process and outcome. The categories generated from the present grounded theory analysis may serve as a foundation for identifying interactions that are associated with agentic involvement in future process research and practice, and hence we have formulated principles/strategies that were identified by the analysis.

Knowing-in-relation: How experienced therapists integrate different sources of knowledge in actual clinical practice.

The present article elaborates on the concept of psychotherapy integration by approaching the issue from the perspective of clinician activity within therapy sessions. Secondary analysis of qualitative data on in-session behavior and posttreatment reflections of highly experienced, pluralistically informed therapists was carried out. The concept of “knowing-in-relation” emerged as a means of representing the moment-to-moment integration of knowledge and practice that was observed. It is argued that integration may be considered as an evolving, processual activity, as well as an implementation of specific integrative models. Saber en Relación: La Manera en la cual Terapeutas con Experiencia Integran Diferentes Fuentes de Sabiduría en su Práctica Clínica El presente artículo elabora los conceptos de la integración de la psicoterapia abarcando el problema desde la perspectiva de la actividad del terapeuta en las sesiones de terapia. También se lleva a cabo un análisis de información cualitativa sobre el comportamiento durante la sesión y reflexiones posttratamiento de terapeutas con un alto nivel de experiencia y pluralistamente informados. El concepto de “saber en relación” surgió como método para representar la integración momento a momento de la sabiduría y la práctica que fue observada. Se cree que la integración puede ser considerada una actividad que evoluciona y que es procesual, así como también, una implementación de modelos integradores específicos.

Alliance formation in high-conflict custody mediation: a serial case analysis

Through an in-depth qualitative analysis of five cases of mandatory high-conflict custody mediation, we analysed interpersonal processes associated with the early formation of a working alliance in a three-way interaction. The analysis showed that the mediator efficiently managed the focus of the conversation and validated the parents’ perspectives, but was reticent in addressing interactional issues. Our findings suggest that mediators in high-conflict custody mediation cases can facilitate the formation of an alliance between the parents, as well as between the mediator and the parents, by taking into account three main aspects of the interaction: (1) the management of the focus of the conversation; (2) validation of the parties’ perspectives; and (3) adapting interventions and tasks to the cohesion of the parent dyad. Practitioner points Mediators support the formation of a collaborative alliance by managing the focus of the conversation and validating parties’ perspectives Low parent dyad cohesion may bar cooperation on seemingly minor issues and a working alliance should be established early on Ample spacing between mediation sessions allows parents time to try out and evaluate different practical arrangements Working on concrete items of a parenting plan contributes to improving cooperation

Identification of Implementation Strategies Used for the Circle of Security-Virginia Family Model Intervention: Concept Mapping Study

Background A reoccurring finding from health and clinical services is the failure to implement theory and research into practice and policy in appropriate and efficient ways, which is why it is essential to develop and identify implementation strategies, as they constitute the how-to component of translating and changing health practices. Objective The aim of this study was to provide a systematic and comprehensive review of the implementation strategies that have been applied for the Circle of Security-Virginia Family (COS-VF) model by developing an implementation protocol. Methods First, informal interviews and documents were analyzed using concept mapping to identify implementation strategies. All documentation from the Network for Infant Mental Health’s work with COS-VF was made available and included for analysis, and the participants were interviewed to validate the findings and add information not present in the archives. To avoid lack of clarity, an existing taxonomy of implementation strategies, the Expert Recommendations for Implementing Change, was used to conceptualize (ie, name and define) strategies. Second, the identified strategies were specified according to Proctor and colleagues’ recommendations for reporting in terms of seven dimensions: actor, the action, action targets, temporality, dose, implementation outcomes, and theoretical justification. This ensures a full description of the implementation strategies and how these should be used in practice. Results Ten implementation strategies were identified: (1) develop educational materials, (2) conduct ongoing training, (3) audit and feedback, (4) make training dynamic, (5) distribute educational materials, (6) mandate change, (7) obtain formal commitments, (8) centralize technical assistance, (9) create or change credentialing and licensure standards, and (10) organize clinician implementation team meetings. Conclusions This protocol provides a systematic and comprehensive overview of the implementation of the COS-VF in health services. It constitutes a blueprint for the implementation of COS-VF that supports the interpretation of subsequent evaluation studies, facilitates knowledge transfer and reproducibility of research results in practice, and eases the replication and comparison of implementation strategies in COS-VF and other interventions.

How Usual is Treatment as Usual? Experienced Therapists’ Reflections on Participation in Practice-based Research.

Abstract Studies have shown that many clinicians are skeptical about research and hesitant about participating in research. In the present study, we explored this issue by studying experienced therapists’ reflections on their participation in practice-based research. Data were drawn from a practice-based research study at the University of Oslo, Norway. Twelve highly experienced therapists who had contributed to the study were invited to complete an open-ended questionnaire regarding their participation, and the text material was analyzed using a thematic analytic approach. Results indicated that research participation was experienced both as beneficial and demanding, and that being observed by others and following research procedures was experienced as affecting therapists’ clinical work. We discuss these findings in relation to the distinction between “treatment as usual” versus “treatment in a research context”, and offer suggestions for steps to increase the clinical relevance and the ecological validity of psychotherapy research.