scholarly journals Understanding the secondary system of therapeutic alliance in autism interventions from the perspectives of parents and caregivers

Author(s):  
John Robert C. Rilveria

AbstractThis study utilized a sequential explanatory mixed-methods design in understanding the secondary system of therapeutic alliance from the perspectives of parents and caregivers of children with autism. In the quantitative phase, data from the accomplished questionnaires of 124 parent–caregiver dyads were collected and analyzed. Four factors extracted from the literature: treatment attitude, treatment compliance, level of stress, and perceived autism severity were examined as possible predictors of parent–therapist alliance, caregiver–therapist alliance, and parent–caregiver alliance. In the qualitative phase, eight parent–caregiver dyads (who both scored high in their alliance with therapist, alliance with each other, treatment attitude, treatment compliance, and level of stress) were interviewed to probe on their experiences of alliance-building, parenting, and caregiving. The integration of both quantitative and qualitative data led to the formulation of a conceptual framework that explains how the factors influence the secondary system of therapeutic alliance. These findings emphasize that tapping into the personal experiences of parents and caregivers can help in identifying what they value in a working, therapeutic relationship. Moreover, communication, skills training, and feedback among therapists, parents, and caregivers are essential to enhance positive attitude toward treatment, promote compliance to treatment recommendations, and address sources of personal stress. Nevertheless, this study calls for future studies to build into the factors associated with the systemic therapeutic alliance and to implement intervention programs that may target issues relating to attitude toward treatment, compliance to treatment, and experience of parental and caregiver stress.

2020 ◽  
Author(s):  
Eric Badu ◽  
Anthony Paul O’Brien ◽  
Rebecca Mitchell ◽  
Akwasi Osei

Abstract Background Evidence-based clinical practice is an inherent component of developed countries mental health professional practice, however, little is known about Ghana mental health professional perspectives on evidence-based practice. This paper outlines the processes involved in the delivery of best practice in Ghana. The paper describes a realistic evaluation of mental health nurses and allied health opinions regarding the evidenced-based therapeutic process in Ghana mental health facilities. Methods A purposive sample of 30 Mental Health Professionals (MHPs) was recruited to participate in semi-structured in-depth interviews. Thematic analysis was used to analyse the data. A programme theory of Context + Mechanism = Outcome (CMO) configuration was developed from the analysis. Results The thematic analysis identified two CMO configurations: 1) technical competency stimulates evidence-based mental health services; and, 2) therapeutic alliance-building ensures effective interaction. The study demonstrated that contextual factors (technical competencies and therapeutic alliance building) together with mechanisms (intentional and unintentional) help to promote the quality of mental health services. However, contextual factor such as the lack of sign language interpreters yielded an unintended outcome such as consumer-provider communication barrier for consumers with hearing impaired and those from linguistically minority background. Conclusion We conclude that government stakeholders and policymakers should prioritize policy documents, periodic monitoring and adequate financial incentives to support the on-going mechanisms that promote mental health professional technical competence and therapeutic alliance building.


2012 ◽  
Vol 177 (5) ◽  
pp. 541-545
Author(s):  
Keith Penska ◽  
Robin Michael ◽  
Stephen C. Messer ◽  
Ryan Smith ◽  
Nancy B. Black ◽  
...  

2019 ◽  
Vol 45 (2) ◽  
Author(s):  
Ursulla Vilella Andrade ◽  
Sandra Maria do Valle Leone de Oliveira ◽  
Marilene Rodrigues Chang ◽  
Edy Firmina Pereira ◽  
Ana Paula da Costa Marques ◽  
...  

ABSTRACT Objective: To evaluate the treatment compliance of patients with paracoccidioidomycosis. Methods: We studied 188 patients with paracoccidioidomycosis admitted to a tertiary referral hospital in the Central-West Region of Brazil from 2000 to 2010, to assess their compliance to treatment. In order to be considered compliant, patients needed to present two established criteria: (1) receive medicines from the pharmacy, and (2) achieve a self-reported utilization of at least 80% of the dispensed antifungal compounds prescribed since their previous appointment. Results: Most patients were male (95.7%), had the chronic form of the disease (94.2%), and were treated with cotrimoxazole (86.2%). Only 44.6% of patients were treatment compliant. The highest loss to follow-up was observed in the first 4 months of treatment (p < 0.02). Treatment compliance was higher for patients with than for those without pulmonary involvement (OR: 2.986; 95%CI 1.351-6.599), and higher for patients with than without tuberculosis as co-morbidity (OR: 2.763; 95%CI 1.004-7.604). Conclusions: Compliance to paracoccidioidomycosis treatment was low, and the period with the highest loss to follow-up corresponds to the first four months. Pulmonary paracoccidioidal involvement or tuberculosis comorbidity predicts a higher compliance to paracoccidioidomycosis therapy.


2020 ◽  
Vol 7 (1) ◽  
pp. 57
Author(s):  
Ricardo Lucena

This is a case report of comorbidity involving psychiatric disorders. The case could only be understood and managed effectively due to the combination of the therapeutic alliance as the cornerstone of mindful medical practice, psychotherapeutic approaches, and medication. A 27-year-old woman started a psychiatric treatment because of her alcohol problem. She drank daily until she passed out. After assessment, she was admitted into a detoxification facility for a month. As an outpatient, she remained abstinent for periods of time (1-9 months). She also struggled with binge eating, purging and disturbed perception of body image (perceiving herself as obese).The therapeutic alliance was the main component of treatment. She felt understood and not judged. She kept an open mind to understand her psychopathology. Psychoeducation was an important tool. It included sessions on addiction and the core symptoms of anorexia nervosa. Behavioural analysis and skills training helped to identify an anxiety disorder at the basis of all clinical presentation. The patient realized how ambivalent she was to change. After several episodes of alcohol use, binge eating and purging, she redefined her life goals. As a result, her motivation to change evolved. She became mindful of triggers and began to have fewer episodes of alcohol use. She could decrease her binge eating, purging behaviour, and became aware of her distorted perception of her body. She accepted to take medication to control her pathological anxiety, as well as started using paced breathing and muscle relaxation. 


Psichologija ◽  
2018 ◽  
Vol 57 ◽  
pp. 74-94 ◽  
Author(s):  
Nichola Booth ◽  
Stephen Gallagher ◽  
Mickey Keenan

[full article, abstract in English; only abstract in Lithuanian] Worldwide, the prevalence rates of autism are increasing. This review looks at the additional stressors that parenting a child with autism can bring, including psychological distress and mental health difficulties. With the difficulties associated with the autism diagnosis and additional demands on the parents, research has shown that parent training, which helps teach parents new skills, may be advantageous. This review also looks at the most commonly used interventions that parents might avail of in order to acquire new skills, and it examines whether they are based in science, pseudoscience or anti-science. Utilizing best practice from evidence-based research, parents can be successfully trained to teach new skills across a variety of different domains. The advantages and disadvantages of one-on-one training sessions versus group training events, as well as the different components that contribute to each, are discussed. A number of training packages are discussed, including Behavioral Skills Training, video modelling and manualized training packages. We conclude that there is substantial evidence showing that packages with behavioral underpinnings are more effective for children with autism. Autism awareness and education is simply not enough – educate the parents using evidence-based practice to help effectively educate the children


2021 ◽  
Author(s):  
Faizatur Rohmi ◽  
Moses Glorino Rumambo Pandin

Abstract Compliance to treatment is one of the important and essential components of healing and schizophrenia patient’s quality of life. Treatment compliance can be improved by identifying internal and external factors from the patient. This review aims to identify Psychosocial, Internal and External Factors of Treatment Compliance of Schizophrenic Patients. The systematic research for articles begins by identifying research articles in four databases, from Scopus, Science Direct, Sage and Proquest in 2019 – 2021 using predetermined keywords. Articles were selected using PRISMA methode, and based on the inclusion and exclusion criteria that set out. Twenty-five articles analyzed in this lyteratur review were all quantitative studies. The results of the research review show that psychosocial, internal factors and external factors are components of supporting compliance to treatment for schizophrenic patients


Author(s):  
U. Yashila Prithika ◽  
Christina Mary P. Paul ◽  
Vishwanath Simha Nethaji ◽  
S. Vishnu ◽  
Wajeeha Rumaiza ◽  
...  

Background: India is world's diabetic capital. Treatment compliance is most important to manage the disease effectively. This study was done to estimate the prevalence of treatment non–compliance among the adult diabetic population and to identify certain risk factors that may be associated with it.Methods: The study was done on 300 diabetics who were chosen through stratified random sampling from urban and rural areas. Information was collected through a questionnaire that had questions on background information of the subject and then on diabetes and treatment compliance. The data entry and analysis were done using statistical package for social sciences (SPSS) version 22. The final data was summarized into percentages and 95% C.I was calculated for the prevalence rates. Cross tabulations were done for various variables. Chi-square values were calculated wherever appropriate and p values were based on the 2 –tailed values. Associations were assessed and 95% confidence interval of odds ratios were found using Epi Info version 7.1.2.Results: The overall prevalence of non-compliance to treatment in diabetics was found to be 29.7% with a 95% CI of 24.5-34.8%. Treatment non–compliance among diabetics was significantly higher among male subjects, subjects from joint families, subjects with family history of diabetes and also subjects with BMI in the normal range.Conclusions: This study shows the high prevalence rates of treatment non–compliance among the diabetic population emphasizes on the need for effective public–private partnerships to effectively reduce the disease burden of diabetes.


Introduction. Current treatment technologies, a significant place is occupied by the issue of interaction between a doctor and a patient. The aim of this study was to determine the level of compliance in children with chronic pathology. Materials and methods. 87 children aged 6 to 17 years were examined, among whom 32 children had idiopathic juvenile arthritis (JIA), 30 children had type 1 diabetes mellitus (DM1) and 25 apparently healthy children made up the control group. All children were interviewed using the Compliance Level Questionnaires for children with chronic pathology or healthy children. All statistical analyzes were performed using the s/n SPSS 17 4a 180844250981. Results. The study of compliance features in patients with IJA showed that the majority (84.4 %) of children had high compliance to treatment, which was much more common than in children with diabetes mellitus (р < 0,01) and control group (р < 0,02). Half of the children with DM1 also had a high level of general compliance. When assessing the structure of compliance in patients with diabetes, moderate levels of all components were found. Children of this group are characterized by an indefinite social position, they act according to the situation. Emotional instability is a typical manifestation. The study of the level of compliance in children of the control group revealed low indicators of general compliancy to the doctor's actions. Each component corresponded to the average level. It was in these children that low indicators of social and behavioral patterns were found, which indicates a negativity towards the treatment process and medical manipulations. Conclusions: 1. Patients with chronic pathology have a higher level of compliance than patients in the control group, which indicates a significant impact on the child's life of the presence of a chronic disease. 2. The level of compliance differs in various chronic diseases, may depend on the characteristics of subjective feelings and medical manipulations. 3. Female patients have a higher level of adherence to treatment, which dictates the need to take into account the gender of the child in the daily work of the doctor, and pay more attention to careful communication with boys.


2020 ◽  
Vol 42 (2) ◽  
pp. 180-186 ◽  
Author(s):  
Heidi Arponen ◽  
Ritva Hirvensalo ◽  
Veronica Lindgren ◽  
Anu Kiukkonen

Summary Background Success of orthodontic removable appliance treatment relies on patient compliance. The aim of this quantitative and qualitative study was to explore the compliance and self-reported experience of adolescents in orthodontic treatment with headgear activator (HGA) or twin-block (TB) appliance. Materials/methods The study group comprised 52 adolescents with a mean age of 12.6 (±1.3) years at the start of the treatment. The patients were treated at a free-of-charge public dental clinic. Participants were randomly allocated to two equal groups to be treated with either HGA or TB. Patient compliance was evaluated as appliance wear time and subjective experience. Appliance wear time was recorded with Theramon® microchip, and the self-reported subjective experience using a questionnaire. Results In total, 30 patients completed the treatment during the follow-up period. HGA was worn on average 7 hours per day and TB 9 hours per day by those patients, who successfully completed the treatment. During a mean observation period of 13 months (range 7–23 months), the mean actual wear time was 43 per cent less than the advised 12 or 18 hours per day in the whole patient group, and 55 per cent in those patients, who completed the treatment. Compliance level was unrelated to the appliance type. Limitations Study assessed a relatively small number of patients. Conclusions/implications Adolescent patients wear HGA and TB less than advised. Individual variation in treatment adherence is considerable. Thereby, microelectronic wear-time documentation can be a cost-effective mean of identifying non-compliance.


2005 ◽  
Vol 64 (1) ◽  
pp. 13-20 ◽  
Author(s):  
Véronique Beretta ◽  
Yves de Roten ◽  
Michael Stigler ◽  
Martin Drapeau ◽  
Mélanie Fischer ◽  
...  

Influence of patient’s interpersonal schemas on the establishment of the therapeutic alliance is examined on a sample of 60 outpatients during first dynamic psychotherapy sessions. To assess interpersonal characteristics, we used the Inventory of Interpersonal Problems (Horowitz et al., 1988) and the patient’s conflictual relationship themes (CCRT; Luborsky & Crits-Christoph, 1998). Alliance was measured with the Helping Alliance Questionnaire. The results show that therapeutic alliance is associated with patient’s wish to be close, to perceive others as being trustworthy and as helpful. Patients with low alliance more often express the wish to be close to others, but perceive others’ responses more negatively, as indicated by their representations of others as “hurtful and untrustworthy” and “unhelpful”. They also present more interpersonal problems linked to a diminished capacity for affiliation. Clinical implications of the results are discussed.


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