Janneke Metselaar

Priorities in the communication needs of adolescents with psychosocial problems and their parents

In patient‐centred care, professionals should recognize their patients needs and adapt their communication accordingly. Studies into patients’ communication needs suggest priorities vary depending on sociodemographic characteristics, and type and severity of the complaints. However, evidence lacks on priorities in the communication needs of adolescents in psychosocial care and their parents.

Discrepancies between adolescents' attributed relevance and experiences regarding communication are associated with poorer client participation and learning processes in psychosocial care

OBJECTIVEnTo examine adolescents attributed relevance and experiences regarding communication, and whether discrepancies in these are associated with clients participation and learning processes in psychosocial care.nnnMETHODSnAdolescents receiving psychosocial care (n=211) completed measures of communication in three domains: affective communication, information provision, and shared decision-making. Participation involved clients attendance and adherence (professional-reported). Learning processes involved clients improved understanding and improved confidence (client and professional-reported).nnnRESULTSnImportant but less often experienced affective communication was associated with low adherence (odds ratio, 95% confidence interval: 2.8, 1.1-6.8), less improvement in understanding (3.7, 1.5-9.0), and less improvement in confidence (4.5, 1.8-11.6). If information provision or shared decision-making was important but less often experienced, adolescents were more likely to demonstrate less improvement in understanding (3.1, 1.1-8.5; 4.2, 1.7-10.8). The combination less important but experienced only had an effect regarding affective communication; these adolescents were more likely to demonstrate less improvement in confidence (6.0, 2.3-15.4).nnnCONCLUSIONnDiscrepancies between attributed relevance and experiences frequently occur. These discrepancies negatively affect adolescents participation and their learning processes, although the pattern differs across communication domains.nnnPRACTICE IMPLICATIONSnCare professionals should pay considerable attention to their clients communication preferences and adapt their communication style when necessary.

Less reduction of psychosocial problems among adolescents with unmet communication needs

Patient-professional communication has been suggested to be a major determinant of treatment outcomes in psychosocial care for children and adolescents. However, the mechanisms involved are largely unknown and no longitudinal studies have been performed. Our aim was, therefore, to assess over the course of 1xa0year, the impact of patient-centered communication on psychosocial problems of adolescents in psychosocial care, including the routes mediating this impact. We obtained data on 315 adolescents, aged 12–18xa0years, enrolled in child and adolescent social or mental health care. We assessed patient-centered communication by comparing the needs and experiences of adolescents with regard to three aspects of communication: affective quality, information provision, and shared decision-making. Changes in psychosocial problems comprised those reported by adolescents and their parents between baseline and 1xa0year thereafter. Potential mediators were treatment adherence, improvement of understanding, and improvement in self-confidence. We found a relationship between unmet needs for affective quality, information provision, and shared decision-making and less reduction of psychosocial problems. The association between the unmet need to share in decision-making and less reduction of psychosocial problems were partially mediated by less improvement in self-confidence (30xa0%). We found no mediators regarding affective quality and information provision. Our findings confirm that patient-centered communication is a major determinant of treatment outcomes in psychosocial care for adolescents. Professionals should be aware that tailoring their communication to individual patients’ needs is vital to the effectiveness of psychosocial care.

Therapists' continuations following I don't know-responses of adolescents in psychotherapy

OBJECTIVEnIn psychotherapy clients I dont know-responses (IDK-responses) to therapists questions are typically considered to be non-cooperating behaviors. How therapists actually handle these behaviors remains unclear. This study therefore aims to assess client-therapist interactions following IDK-responses.nnnMETHODSnData were collected in a Dutch child and adolescent mental healthcare service by observing Dialectical Behavior Therapy aimed at adolescents with severe emotional distress. Eighteen individual psychotherapy sessions involving two therapists with six clients were video-recorded and transcribed. Stand-alone IDK-responses were selected (n=77) and analyzed using conversation analysis.nnnRESULTSnAdolescents IDK-responses led to varying actions of therapists. We identified five categories of continuations after IDK-responses: no IDK-related continuation; redoing of the question; proposing a candidate answer; employing therapy-specific techniques; and meta-talk on the problematic nature of the IDK-response.nnnCONCLUSIONSnTherapists treat IDK-responses not just as non-cooperative behavior on the part of the client; IDK-responses are also used as a starting point to collaboratively enhance clients insights in their own thoughts, emotions, and behaviors.nnnPRACTICE IMPLICATIONSnAfter IDK-responses therapists can use a variety of continuation strategies with varying therapeutic functions. These strategies can be embedded in training of therapists to deal with potentially non-cooperative behavior.