Health Professional Communication Competences and Patient Evaluation in the Therapeutic Encounter

This chapter focuses on the health professionals' competences and inherent evaluation by patients during the therapeutic relationship. It is grounded on a literature review and proposals on best practices to adopt in health encounters. It can be concluded that the use of communication competences by health professionals influences the patients' evaluation and their health outcomes, demonstrating that “it takes two to tango.” Results have shown that, among the communication competences, are empathy, respect, inclusion of patient in health decisions, confirmation of understanding, use of a plain language, positivity. On the patients' side, the expectations tend to be related to the communication styles of health professionals, the humanization of relationship, and the use of a personalized communication; the communication lapses are more associated with poor attitudes of health professionals, and the patients' sociodemographic attributes influence their expectations.

“Like I’m Talking to a Real Person”: Exploring the Meaning of Transference for the Use and Design of AI-Based Applications in Psychotherapy

AI-enabled virtual and robot therapy is increasingly being integrated into psychotherapeutic practice, supporting a host of emotional, cognitive, and social processes in the therapeutic encounter. Given the speed of research and development trajectories of AI-enabled applications in psychotherapy and the practice of mental healthcare, it is likely that therapeutic chatbots, avatars, and socially assistive devices will soon translate into clinical applications much more broadly. While AI applications offer many potential opportunities for psychotherapy, they also raise important ethical, social, and clinical questions that have not yet been adequately considered for clinical practice. In this article, we begin to address one of these considerations: the role of transference in the psychotherapeutic relationship. Drawing on Karen Barad’s conceptual approach to theorizing human–non-human relations, we show that the concept of transference is necessarily reconfigured within AI-human psychotherapeutic encounters. This has implications for understanding how AI-driven technologies introduce changes in the field of traditional psychotherapy and other forms of mental healthcare and how this may change clinical psychotherapeutic practice and AI development alike. As more AI-enabled apps and platforms for psychotherapy are developed, it becomes necessary to re-think AI-human interaction as more nuanced and richer than a simple exchange of information between human and nonhuman actors alone.

The “Muscles of the Psyche”: From Body Literacy to Emotional Literacy

Autism spectrum disorder (ASD) is a neuro-developmental condition, which requires a multi-disciplinary matrix of treatments, including functional, educational, and emotional interventions. The latter mode of treatment entails particular difficulties, inasmuch as the core deficits of this condition seem to challenge the very premises of traditional psychotherapy. Reciprocity, verbal, and symbolic expression and inter-subjective dynamics are often difficult to attain with clients diagnosed with ASD, and emotional treatment thus often turns out to be a frustrating process, which may well elicit questions as to the efficacy of psychotherapeutic emotional interventions. These core challenges, described in the literature, become particularly acute in view of the increasing number of clients diagnosed on the autistic spectrum in recent years, and the growing need for qualified therapists who have trained for working specifically with this condition. It seems, therefore, that it is high time for systematic research into the lived experience of therapists working with these clients in order to attain a better clinical and theoretical understanding of the condition itself and broaden the range of effective interventions. This study, informed by a phenomenological-hermeneutic approach which guided both the collection of data and its subsequent analysis, aims to address these issues by exploring the particular challenges faced by therapists in this field, the questions that come up in the process, modes of personal and professional coping, and the insights elicited by the therapeutic encounter. The research consisted of in-depth interviews with 28 practicing therapists from a broad range of clinical orientations, including dance/movement, arts, music, and drama therapists, clinical psychologists, and clinical social workers. The essential themes that emerged from the participants’ responses and the analysis of the findings lend support to theoretical and developmental approaches, which focus on the primacy and the foundational role of the concrete body in inter-subjective relationships and in the therapeutic process, and indicate the potential efficacy of somatic and kinetic interventions. The clinical implications of this study are thus highly relevant to the training and support of therapists working with ASD, who should be encouraged to develop greater receptivity to non-verbal modes of interaction in the therapeutic process.

Diagnostic Practices and Treatment for P. vivax in the InterEthnic Therapeutic Encounter of South-Central Vietnam: A Mixed-Methods Study

Malaria elimination in the Greater Mekong Sub-Region is challenged by a rising proportion of malaria attributable to P. vivax. Primaquine (PQ) is effective in eliminating the parasite’s dormant liver stages and can prevent relapsing infections, but it induces severe haemolysis in patients with Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency, highlighting the importance of testing enzyme activity prior to treatment. A mixed-method study was conducted in south-central Vietnam to explore the factors that affect acceptability of G6PD testing, treatment-seeking behaviors, and adherence to current regimens. The majority of respondents (75.7%) were unaware of the different parasite species and rather differentiated malaria by perceived severity. People sought a diagnosis if suspected of malaria fever but not if they perceived their fevers as mild. Most respondents agreed to take prescribed medication to treat asymptomatic infection (94.1%) and to continue medication even if they felt better (91.5%). Health professionals did not have G6PD diagnostic tools nor the means to prescribe PQ safely. Adherence to treatment was linked to trust in public providers, who were perceived to make therapeutic decisions in the interest of the patient. Greater focus on providing acceptable ways of assessing G6PD deficiency will be needed to ensure the timely elimination of malaria in Vietnam.

THEATRE MARAE: Māori theatre pedagogy in research

Theatre Marae is a contemporary theatre practice unique to Aotearoa New Zealand, and this article outlines its application as an Indigenous-informed creative framework for qualitative research. As a research methodology, Theatre Marae is based in a conceptual partnership between traditional and contemporary Māori performing arts, applied theatre and the therapeutic encounter. As a form of theatre pedagogy, Theatre Marae has been applied as a decolonising strategy in ensemble work, and to craft evocative theatre that honours Māori expressions of colonisation, trauma and social justice. Theatre Marae projects have been carried out in kāinga, schools, prisons, youth justice residential centres, community centres and mainstream theatres throughout Aotearoa New Zealand. Although its creative and therapeutic outcomes are influenced by both Western and Māori psychologies and performance traditions, the underlying principles and day-to-day practice of Theatre Marae are based in te ao Māori. This configuration positions Theatre Marae as an Indigenous creative framework that is also applicable to Kaupapa Māori arts-based research.

The Brief Strategic Treatment of Cardiophobia: A Clinical Case Study

Many individuals presenting to medical settings with heart-related symptoms for which no medical explanation is found might suffer from cardiophobia, but this condition is still poorly identified and addressed. This article presents a case of cardiophobia treated in an outpatient cardiac rehabilitation unit and, for the first time, describes the application of brief strategic therapy for the treatment of this condition. In the case reported, the first therapeutic encounter and the key elements of the strategic approach are described in detail with the aim to explain how brief strategic therapy works and how it can be used to identify and address cardiophobia-related behaviors. A 64-year-old male presented to cardiac rehabilitation reporting intense anxiety-provoking heart palpitations, and believing he was at risk of dying from a heart attack. After 3 sessions, an overall improvement in heart-related bodily sensations followed a decrease in the patient’s continuous checking of his heartbeat and seeking reassurance—factors that were largely responsible for the persistence of the problem. Moreover, quantitative evaluation showed increased scores of mood state at the end of treatment. This improvement persisted at the 18-month follow-up. This case is an interesting example of how brief strategic therapy can contribute to the development of a new conceptual model for the diagnosis and treatment of cardiophobia. Still, more systematic research in the field is needed to prove the efficacy and effectiveness of this therapeutic approach on symptoms of heart-focused anxiety.

Psychotherapists’ altered states of consciousness

The majority of research that has been conducted around counselling and psychotherapy has been directed towards the evaluation of client outcome and client experience. Studies concentrated solely on therapist experience during the therapeutic encounter are largely in the minority. The purpose of this study was to explicate a deeper understanding of the unusual and unforgettable events that led to dramatic shifts in consciousness experienced by some counsellors and psychotherapists during the therapeutic hour. A study group of six participants was assembled via open invitation. The group comprised of three student counsellors nearing the end of their studies and three qualified therapists of varying degrees of experience. A semi-structured interview process provided transcriptions of the participant experiences, and an interpretative phenomenological analysis was conducted. This study found that the willingness to be open to the presence and essence of another, on both sides of the therapeutic dyad, had the potential to contribute to the intense, powerful and profound experiences arising in the therapist. In all cases, the unusual events and altered states led to the deepening of the healing potential within the therapy whilst simultaneously providing developmental propulsion for each practitioner.

A ‘commonsense’ psychoanalysis: Listening to the psychosocial dreamer in interwar Glasgow psychiatry

This article historicises a dream analytic intervention launched in the 1930s by Scottish psychiatrist and future professor of psychological medicine at the University of Glasgow (1948–73), Thomas Ferguson Rodger (1907–78). Intimate therapeutic meetings with five male patients are preserved within the so-called ‘dream books’, six manuscript notebooks from Rodger’s earlier career. Investigating one such case history in parallel with lecture material, this article elucidates the origins of Rodger’s adapted, rapport-centred psychotherapy, offered in his post-war National Health Service, Glasgow-based department. Oriented in a reading of the revealing fourth dream book, the article unearths a history of the reception and adaptation of psychoanalysis from within a therapeutic encounter and in a non-elite context. Situating Rodger’s psychiatric development in his Glasgow environment, it then contextualises the psychosocial narrative of the fourth book in relation to contrasting therapeutic commitments: an undiluted Freudianism and a pragmatic ‘commonsense’ psychotherapy, tempered to the clinical psychiatric, and often working-class, interwar Glasgow context. An exploration of pre-recorded dreams, transcribed free associations, and ‘weekly reports’ reveals that in practice, Rodger’s Meyerian attitude worked productively with Freudian techniques to ennoble the patient’s psychosocial testimony and personal wisdom. This psychotherapeutic eclecticism underpinned and made visible the patient’s concurrent faith in and resistance to psychoanalytic interpretation. Chronicling a collaborative route to psychotherapeutic knowledge within a discrete encounter, the article situates post-war treatment values in the interwar impasse of outpatient psychiatry.