Psychotherapists Working in Private Practice During a Pandemic: A Literature Review

Psychotherapists in private practice provide services to an ever-growing client population. The 2020 novel Corona Virus (COVID-19) pandemic was a catalyst for emerging and exasperated mental health concerns among the U.S. population. The result was an increase in demand for services and private practitioners stepping up to meet this growing need. Little is known about the psychotherapists who embark on independent practice and less is known about the nuances of practicing during a global pandemic. The aim of this review was to exhaust the literature on private practice psychotherapy and the practice of psychotherapy during COVID-19, synthesize the findings, report on themes in the literature, and provide recommendations for future lines of inquiry. Themes from this review included the impact of COVID-19 on public mental health, telemental health, private practice shifts, and private practice careers.

Sick and Tired—Sociodemographic and Psychosocial Characteristics of Asylum Seekers Awaiting an Appointment for Psychotherapy

Background: An EU directive holds the EU member states responsible for implementing the provision of health care for asylum seekers. However, current literature indicates insufficient care for asylum seekers in the German health system. This article aims to characterize the situation of the client population on the waiting list of a psychosocial center (PSZ). Methods: We conducted a retrospective observational study based on client files in Halle (Saale), Germany. We included 437 adults who were on the PSZ waiting list between 2016 and 2019. Questionnaires that collected information on the clientele at two different times were analyzed. Results: The average waiting time for psychotherapy was 50 weeks. In total, 85.6% of the 188 respondents reported sleep disorders (n = 161), 65.4% of clients reported pain (n = 123) and 54.8% suicide attempts/suicidal thoughts (n = 54). In the 16-week waiting period in which the clients waited for an initial appointment with a psychologist, the residence status deteriorated in 21.3% (n = 40). Conclusion: Improving asylum seekers’ access to the German health system is urgently needed in order to prevent unnecessary suffering in the future and to comply with EU law.

Web based Acceptance and Commitment Therapy (ACT) for symptoms of anxiety and depression: Within-group effect size benchmarks as tools for clinical practice

COVID-19 has highlighted the need for evidence-based behavioural health interventions that can be delivered remotely. This article provides within-group effect size benchmarks for randomised controlled trials of Internet-based Acceptance and Commitment Therapy for the treatment of adults with anxiety and depression. Effect sizes were calculated using the Glass approach, adjusted using Hedges g, then aggregated to produce separate benchmarks for measures of anxiety and depression. These benchmarks can be used by community-based treatment providers to evaluate the effectiveness of their Web-based Acceptance and Commitment Therapy intervention to determine if it should be continued, modified for the unique needs of their client population and practice setting, or discontinued.

Baby steps: a report exploring the development of neonatal music therapy programmes in Estonia, Greece and Wales

There is a growing body of music therapy work addressing the needs of infants born prematurely. This also includes work with parents and other family members during hospitalisation. A variety of music therapy interventions are utilised to support a range of treatment goals for this client population. This report describes and discusses such work that is in the early stages of development in 3 European countries: Estonia, Greece and Wales. The development and content of the interventions in each country is described, with recommendations as to the sustainability and future growth of each programme

Longitudinal whole-genome based comparison of carriage and infection associated Staphylococcus aureus in northern Australian dialysis clinics

Background The study objective was to reveal reservoirs potentially leading to Staphylococcus aureus infections in haemodialysis clinic clients in the tropical north of the Australian Northern Territory (NT). This client population are primarily Aboriginal Australians who have a greater burden of ill health than other Australians. Reservoir identification will enhance infection control in this client group, including informing potential S. aureus decolonisation strategies. Methods and findings The study participants were 83 clients of four haemodialysis clinics in the Darwin region of the NT, and 46 clinical staff and researchers who had contact with the clinic clients. The study design was longitudinal, encompassing swabbing of anatomical sites at two month intervals to yield carriage isolates, and also progressive collection of infection isolates. Swab sampling was performed for all participants, and infection isolates collected for dialysis clients only. Analysis was based on the comparison of 139 carriage isolates and 27 infection isolates using whole genome sequencing. Genome comparisons were based on of 20,651 genome-wide orthologous SNPs, presence/absence of the mecA and pvl genes, and inferred multilocus sequence type and clonal complex. Pairs of genomes meeting the definition of “not discriminated” were classed as defining potential transmission events. The primary outcome was instances of potential transmission between a carriage site other than a skin lesion and an infection site, in the same individual. Three such instances were identified. Two involved ST762 (CC1) PVL- MRSA, and one instance ST121 PVL+ MSSA. Three additional instances were identified where the carriage strains were derived from skin lesions. Also identified were six instances of potential transmission of a carriage strains between participants, including transmission of strains between dialysis clients and staff/researchers, and one potential transmission of a clinical strain between participants. There were frequent occurrences of longitudinal persistence of carriage strains in individual participants, and two examples of the same strain causing infection in the same participants at different times. Strains associated with infections and skin lesions were enriched for PVL and mecA in comparison to strains associated with long term carriage. Conclusions This study indicated that strains differ with respect to propensity to stably colonise sites such as the nose, and cause skin infections. PVL+ strains were associated with infection and skin lesions and were almost absent from the carriage sites. PVL- MRSA (mainly CC1) strains were associated with infection and also with potential transmission events involving carriage sites, while PVL- MSSA were frequently observed to stably colonise individuals without causing infection, and to be rarely transmitted. Current clinical guidelines for dialysis patients suggest MRSA decolonisation. Implementation in this client group may impact infections by PVL- MRSA, but may have little effect on infection by PVL+ strains. In this study, the PVL+ strains were predominant causes of infection but rarely colonised typical carriage sites such as the nose, and in the case of ST121, were MSSA. The important reservoirs for infection by PVL+ strains appeared to be prior infections.

Hybrid Professional Identities

Focused upon occupational professionals in an organizational context, and their transition towards being a managerial or commercial hybrid, the authors of this chapter debate whether such a transition represents progressive or regressive professionalism. They balance consideration of agency enacted by the individual professional, with that of the institutional challenge transition constitutes. They highlight the extent to which the individual professional can enact agency is influenced by their status. A powerful professional may be able to blend, buffer, or decouple competing institutional logics, and so remain in control of the transition to retain their autonomy and even aggrandize their status. Simultaneously, organizations may gain from more efficient and effective utilization of resource across the wider client population. If transition towards hybrid professional identity is thus seen as desirable by both organizations and professionals, then organizational support is required, in large part to socialize the incoming role holder towards the demands of the new role through liminal spaces, specifically networks, education, and mentoring. Nevertheless, in their analysis, the authors caution taking an overly optimistic view of hybrid transition. Lower status professionals may experience reduced levels of personal control through interventions that foist on them managerial or commercial identities. In short, we need to take a more nuanced view of professional responses to hybrid transitions.

Four Relational Experiences in Music Therapy with Adults with Severe and Profound Intellectual Disability

This paper describes a conceptual framework in music therapy with adults with severe and profound levels of intellectual disability. Drawing from Carl Rogers’ person-centered work and his notion of the good life as a direction, the author presents four core relational experiences (curiosity, invitation, celebration, and recognition) that underpin the therapeutic process with this client population. Case vignettes from the author’s clinical work illustrate how core experiences are presented through improvisational musical experiences. Considerations are given to the clinical significance of good-life-oriented experiences on the emotional health of individuals with severe and profound intellectual disability, and to its implications beyond the music therapy space.

Group Art Therapy, Aesthetic Experiences of Difference and Belonging

This paper comes from a qualitative doctoral study which explored the impact of group art therapy on people affected by Parkinson’s. It specifically addresses the research question: How might participating in art therapy groups support wellbeing and better functioning for people affected by Parkinson’s? Art therapy is not a widely applied therapeutic intervention for this client population. The study was undertaken at the Catalan Parkinson’s Association which has a long-standing art therapy service integrated into the therapeutic rehabilitation programme. The language-based data gathered for analysis was from four focus group encounters with people affected by Parkinson’s (who had directly experienced group art therapy), family members and professionals from the multidisciplinary team working alongside the art therapist. A thematic network analysis (Attride-Stirling, 2001) was undertaken producing six global themes in response to the research question: self-construction; material action; an aesthetic group movement; new perspectives; artwork as legacy; physical transformation as a relational aesthetic experience. I first describe how the research participants joined the study, the rationale for the focus groups and their composition; followed by a detailed exploration of the six themes, relating them to wider literature and a discussion of their implications for practice.

Analysing aggregate clinical data to support evaluation of the Tackling Indigenous Smoking program, 2014–16

Objective The aim of this study was to assess the change in recording of client population smoking attributes (smoking status recorded and smoking status) in Tackling Indigenous Smoking (TIS)-funded services compared with non-funded services for Aboriginal and Torres Strait Islander people, 2014–16. Methods The study included a cohort of 152 Aboriginal-community controlled services with aggregate client smoking data from 2014 to 2016. Negative binomial regression was used to assess change in smoking status recorded and smoking status between TIS and non-TIS funded organisations. The models controlled for size of client population, jurisdiction and remoteness. Results From 2014 to 2016, the overall reporting rate (change in recording of smoking status) of client smoking status was 1.58-fold higher (95% confidence interval (CI) 1.30–1.91; P<0.001) in TIS-funded than non-TIS-funded services after controlling for year, remoteness and their interaction. The highest change in reporting of client smoking status was for TIS-funded services in remote areas (reporting ratio 6.55; 95% CI 5.18–8.27; P<0.001). In 2016, TIS-funded services reported higher overall levels of recording client smoking status (current, ex- and non-smokers) than non-TIS funded services (RR 1.11; 95% CI 1.00–1.28; P<0.001). There was no significant change in the reporting of smokers, ex-smokers or non-smokers over the three reporting periods. Conclusion The analysis shows higher reporting of the proportion of the service client population for services funded under the TIS program compared with non-TIS-funded services. Existing evidence suggests that following-up smokers with targeted clinical interventions once they have had smoking status recorded could reduce smoking rates in the long term. The public health contribution of this study has defined one method for assessing smoking attributes when using aggregate health service data. This method could be applied to future tobacco control programs in health services. What is known about the topic? Aboriginal and Torres Strait Islander smoking prevalence is high. The Aboriginal and Torres Strait Islander primary healthcare providers’ national key performance indicators (nKPIs) are one data source that can track changes over time in smoking in clients of these services. What does this paper add? This paper presents the first analytical study and evaluation of the nKPI dataset items on smoking. What are the implications for practitioners? There is value in analysing routinely collected data in program evaluations. The method used in this paper demonstrates one approach that could be used to assess smoking indicators and their changes over time in TIS program evaluation.

Therapeutically Supporting Children to Recover from the Impact of Family Violence

Family violence (also referred to as Domestic Violence and Intimate Partner Violence) describes violence that occurs within an intimate relationship, whether a current or former partner. Children can experience a range of abuses (emotional, physical, sexual and neglect) within the context of family violence, and harm is cumulative and may present as complex trauma. This paper is based on a practice presentation delivered at the International Childhood Trauma Conference in Melbourne (Australia) in June 2016. The purpose of this paper is to increase awareness of the impacts for children who have experienced family violence, to enhance understanding of the mechanisms that contribute to their trauma presentation, and to highlight the specific practice issues and considerations in providing therapeutic support to this client population, with the ultimate aim of improving diagnostic and treatment outcomes for children impacted by family violence. Sufficient safety and stability are required for children to experience therapeutic change, and if family violence is current, the initial response needs to be protective. Identification of family violence should prompt practitioners to use trauma-informed assessment and trauma-focused evidence-based treatments within a family therapy and systems framework. Family violence is complex and there are many barriers to treatment and practice considerations. Expansion of practitioner knowledge and skills in family violence trauma will enhance outcomes for children who have experienced family violence.