Homebound Elderly People Psychotherapeutic Intervention (HEPPI): study protocol for a randomized controlled trial / Intervenção psicoterapêutica com adultos idosos confinados no domicílio: protocolo para um ensaio clínico randomizado controlado

Objective: To present the study protocol for the Homebound Elderly People Psychotherapeutic Intervention (HEPPI), a home-delivered cognitive-emotional intervention aimed at homebound older adults with mild cognitive impairment and depression and/or anxiety symptoms. Methods: A two-arm, open-label, parallel-group randomized controlled trial will be conducted to compare the effects of HEPPI with treatment as usual. Homebound older adults will be recruited from the community through contact with their health care networks in mainland Portugal. All participants will complete baseline, post-intervention, and 3-month follow-up assessments. Primary outcomes will be changes in episodic memory and depression and anxiety symptoms. Secondary outcomes will include changes in general cognition, attentional control, subjective memory complaints, quality of life, functional status, and loneliness. Relevance: The availability of evidence-based home-delivered non-pharmacological interventions meeting the cognitive and emotional needs of the homebound older population could improve their access to mental health care resources and increase their mental health and quality of life.

Objetivo: Apresentar o protocolo do estudo da Homebound Elderly People Psychotherapeutic Intervention (HEPPI), uma intervenção cognitivo-emocional, realizada no domicílio, dirigida a adultos idosos confinados no domicílio com declínio cognitivo leve e sintomatologia depressiva e/ou ansiógena. Métodos: Será realizado um ensaio clínico randomizado, controlado e aberto, com o objetivo de comparar os efeitos da intervenção HEPPI com um grupo de tratamento usual. Os idosos confinados no domicílio serão recrutados na comunidade, em Portugal continental, por meio de contato com sua rede de prestação de cuidados de saúde. Todos os participantes serão avaliados em três momentos: pré-intervenção, pós-intervenção e três meses depois da intervenção. As alterações na memória episódica e na sintomatologia depressiva e ansiógena serão os desfechos primários, já os secundários serão constituídos pelas alterações no funcionamento cognitivo geral, controle atencional, queixas subjetivas de memória, qualidade de vida, capacidade funcional e solidão. Relevância: A disponibilidade de intervenções não farmacológicas em domicílio com evidência empírica, que atendam às necessidades cognitivas e emocionais dos adultos idosos confinados no domicílio, poderá facilitar o seu acesso a recursos de saúde mental, bem como melhorar sua saúde mental e qualidade de vida.

Uma formação pedagógico-reflexiva em psicologia: análise de diários de aprendizagem / A pedagogical-reflexive experience at a Psychology course: analysis of learning logs / Una formación pedagógica-reflexiva en Psicología: análisis de diarios de aprendizaje

O presente artigo buscou, através da análise de diários de aprendizagem, discutir a respeito das possibilidades que uma formação universitária em psicologia que seja acolhedora e promotora de reflexões pode ter na formação de estudantes de psicologia. Foram analisados treze diários redigidos por estudantes do sexto semestre de um curso de graduação em Psicologia matriculados em uma disciplina relacionada à Abordagem Centrada na Pessoa de um Centro Universitário do Centro-Oeste brasileiro. Os diários foram escritos tendo como base a concepção de Versão de Sentido, com uma escrita livre após as aulas. Foi utilizada a Análise Temática e, a partir dela emergiram seis temas que demonstraram a importância da construção de um espaço acadêmico dialógico que promova as condições facilitadoras para o desenvolvimento pessoal e profissional.

The present article aimed, through the analysis of learning diaries, to discuss about the possibilities that a psychology university degree which promotes reflection and shelters students' thoughts and emotions can have in the training of psychology students. Were analyzed thirteen learning logs written by students of the sixth semester of an undergraduate degree course in Psychology enrolled in a discipline related to the Person Centered Approach.The logs were written based on the Sense's Version, after each class, with indication of free writing. Thematic Analysis was used, and from it six themes emerged that demonstrated the importance of building an academic context that promotes the facilitating conditions for personal and professional development.

El presente artículo buscó, a través del análisis de diarios de aprendizaje, discutir acerca de las posibilidades que una formación universitaria en psicología que sea acogedora y promotora de reflexiones puede tener en la formación de estudiantes de psicología. Se analizaron trece diarios redactados por estudiantes del sexto semestre de un curso de graduación en Psicología matriculados en una disciplina relacionada al Enfoque Centrado en la Persona. Los diarios fueron escritos teniendo como base la concepción de Versión de Sentido, con una escritura libre después de las clases. Se utilizó el Análisis Temático y, a partir de ella surgieron seis temas que demostraron la importancia de la construcción de un espacio académico dialógico que promueve las condiciones facilitadoras para el desarrollo personal y profesional.

Um percurso gadameriano na produção de conhecimento em Abordagem Centrada na Pessoa / A gadamerian route in the production of knowledge in a Person-Centered Approach / Una ruta gadameriana en la producción de conocimientos en un Enfoque Centrado en la Persona

O presente artigo objetiva apresentar o percurso teórico-metodológico, construído pelo primeiro autor em sua Dissertação de Mestrado sob a orientação do segundo, baseado na filosofia hermenêutica de Hans-Georg Gadamer. Justifica-se sua relevância por ser uma alternativa estruturada para a realização de pesquisas bibliográficas dentro do escopo da Abordagem Centrada na Pessoa (ACP). Para isso, procura-se inicialmente justificar a escolha da hermenêutica gadameriana em sua relação com o objetivo da pesquisa. Em seguida, apresenta-se a rede conceitual formada pela articulação das concepções preconceito, linguagem, tradição, atualização e fusão de horizontes que sustentam essa perspectiva, de forma que permita, posteriormente, sistematizar as fases investigação das informações, análise compreensiva e síntese hermenêutica para o desenvolvimento da pesquisa sobre o problema proposto. Finaliza-se o artigo com a constatação da potencialidade e proficuidade referente à aproximação, e consequente articulação, entre a ACP e a perspectiva filosófica gadameriana, com reflexões sobre as implicações quanto ao uso de um método hermenêuticofilosófico na produção de conhecimento na abordagem.

This article aims to present the theoretical-methodological route, built by the first author in his Master's Dissertation under the guidance of the second, based on Hans-Georg Gadamer hermeneutic-philosophical philosophy. Its relevance is justified because it is a structured alternative for conducting bibliographic research within the scope of the Person Centered Approach (PCA). For this, we initially want to justify an epistemological choice of gadamerian hermeneutics in its relation to the research objective. Then, we present the conceptual network formed by the articulation of prejudice, language, tradition, update and fusion of horizons that supports this perspective, in a ways that allows, later, to systematize the phases of information investigation, comprehensive analysis and hermeneutic synthesis to the development of research on the proposed problem. The article ends with the observation of the potentiality and proficiency related to the approximation, and consequent articulation, between PCA and the Gadamerian philosophical perspective, with reflections on the implications regarding the use of a hermeneutic-philosophical method in the production of knowledge in the approach.

El presente artículo tiene como objetivo presentar el camino teórico-metodológico, construido por el primer autor en su disertación de maestría bajo la guía del segundo, basado en la filosofía hermenéutica de Hans-Georg Gadamer. Su relevancia se justifica porque es una alternativa estructurada para realizar investigaciones bibliográficas dentro del alcance del Enfoque Centrado en la Persona (ECP). Para eso, se busca inicialmente justificar la elección de la hermenéutica gadameriana en su relación con el objetivo de la investigación. En seguida, presenta-se la red conceptual formada por la articulación de las concepciones prejuicio, lenguaje, tradición, atualización, y fusión de horizontes que sostiene esa perspectiva de forma que permita, posteriormente, sistematizar las fases investigación de las informaciones, analisis comprensiva y síntesis hermenéutica para el desarrollo de la investigación sobre el problema propuesto.El artículo finaliza con la verificación de la potencialidad y rentabilidad relacionadas con la aproximación, y la articulación consiguiente, entre ECP y la perspectiva filosófica gadameriana, con reflexiones sobre las implicaciones con respecto al uso de un método hermenéutico-filosófico en la producción de conocimiento en el enfoque.

Da ludoterapia não-diretiva à ludoterapia centrada na criança - desenvolvimento histórico / From non-directive play therapy to child-centered play therapy - historical development / De la terapia de juego no-directiva a terapia de juego centrada en el nino - desarollo histórico

O desenvolvimento da Abordagem Centrada na Pessoa foi dividido em fases que apresentam as atitudes que fazem parte da relação terapêutica, independente do público atendido. Contudo, na especificidade da psicoterapia infantil, o desenvolvimento teórico e prático da própria abordagem aponta para a existência de peculiaridades. Este estudo tem como objetivo apresentar, através de uma revisão narrativa de literatura, fundamentada na hermenêutica filosófica de Gadamer, as possíveis características relativas ao atendimento de crianças a partir de um retorno às fases da ACP. Discutimos os fundamentos iniciais do atendimento com crianças em Rogers ena perspectiva clássica de Axline, compreendendo como a ludoterapia com crianças se caracteriza nas fases não-diretiva, reflexiva, experiencial e pós-rogeriana. Discutimos sobre propostas contemporâneas nos contextos europeu, estadunidense e brasileiro. Concluímos que essa delimitação do atendimento infantil possibilita uma percepção mais clara das mudanças e aprimoramentos em relação aos trabalhos pioneiros de Rogers e Axline, sempre tendo como eixo a dimensão relacional e a tendência ao crescimento como motor do processo terapêutico.

The development of the Person-Centered Approach was divided into phases that presents the attitudes that are part of therapeutic relationship, regardless of the public served. However, in the specificity of child psychotherapy, the theoretical and practical development of the approach points to the existence of peculiarities. This study aims to present, through narrative literature review, based on Gadamer's philosophical hermeneutics, the possible characteristics related to the child therapy, starting from a return to the PCA phases. We discuss the foundations of child therapy in Rogers and Axline's classic perspective, understanding how child play therapy is characterized in non-directive, reflective, experiential and post-Rogerian phases. We discuss contemporary proposals in the European, American, and Brazilian contexts. We conclude that this delimitation enables a clearer perception of changes and improvements amongst to the Rogers and Axline's pioneering work, always having as its axis the relational dimension and the tendency to growth as a motor of the therapeutic process.

El desarrollo del Enfoque Centrado en la Persona se dividió en fases que presentan las actitudes de la relación terapéutica, independiente del público. Sin embargo, en la especificidad de la psicoterapia infantil, el desarrollo teórico y práctico del enfoque en sí mismo apunta la existencia de peculiaridades. Este estudio tiene como objetivo presentar, a través de una revisión narrativa de la literatura, basado em la hermenéutica filosófica de Gadamer, las posibles características de la psicoterapia con niños, desde el retorno a las fases de ECP. Discutimos los fundamentos de la psicoterapia con niños en Rogers, la perspectiva clásica de Axline, comprendiendo como la terapia de juego com los niños se caracterizan em las fases no directiva, reflexiva, experiencial y pos-rogeriana. Discutimos propuestas contemporáneas en los contextos europeo, estadounidense y brasileño. Concluimos que esta delimitación permite una percepción más clara de los cambios y mejoras en relación con los trabajos pioneros de Rogers y Axline, teniendo siempre como eje la dimensión relacional y la tendencia al crecimiento como motor del proceso terapéutico.

Personalising psychotherapies for depression using a novel mixed methods approach: an example from Morita therapy.

BACKGROUND: Current quantitative methods for personalising psychotherapies for depression are unlikely to be able to inform clinical decision-making for hundreds of years. Novel alternative methods to generate hypotheses for prospective testing are therefore required, and we showcase mixed methods as one such approach. By exploring patients' perspectives in depth, and integrating qualitative and quantitative data at the level of the individual, we may identify new potential psychosocial predictors of psychotherapy outcomes, potentially informing the personalisation of depression treatment in a shorter timeframe. Using Morita therapy (a Japanese psychotherapy) as an exemplar, we thus explored how Morita therapy recipients' views on treatment acceptability explain their adherence and response to treatment. METHODS: The Morita trial incorporated a pilot randomised controlled trial of Morita therapy versus treatment as usual for depression, and post-treatment qualitative interviews. We recruited trial participants from general practice record searches in Devon, UK, and purposively sampled data from 16 participants for our mixed methods analysis. We developed typologies of participants' views from our qualitative themes, and integrated these with quantitative data on number of sessions attended and whether participants responded to treatment in a joint typologies and statistics display. We enriched our analysis using participant vignettes to demonstrate each typology. RESULTS: We demonstrated that (1) participants who could identify with the principles of Morita therapy typically responded to treatment, regardless of how many sessions they attended, whilst those whose orientation towards treatment was incompatible with Morita therapy did not respond to treatment, again regardless of treatment adherence and (2) participants whose personal circumstances impeded their opportunity to engage in Morita therapy attended the fewest sessions, though still benefitted from treatment if the principles resonated with them. CONCLUSIONS: We identified new potential relationships between "orientation" and outcomes, and "opportunity" and adherence, which could not have been identified using existing non-integrative methods. This mixed methods approach warrants replication in future trials and with other psychotherapies to generate hypotheses, based on typologies (or profiles) of patients for whom a treatment is more or less likely to be suitable, to be tested in prospective trials. TRIAL REGISTRATION: Current Controlled Trials, ISRCTN17544090. Registered on 23 July 2015.

Demonstrating Nursing Excellence Through Equality: The Relationship Between Magnet® Status and Organizational LGBTQ Client Services and Support.

Introduction: Human Rights Campaign annually scores health care treatment of lesbian, gay, bisexual, transgender, and queer (LGBTQ) employees and clients among four measured dimensions in its Healthcare Equality Index (HEI). The purpose of this study was to determine if the score organizations earned on the 2018 HEI dimension measuring LGBTQ client services and support correlated with organizations' American Nurses Credentialing Center Magnet® recognition status, a distinction of nursing excellence. Method: Using a secondary data analysis approach, data obtained from Human Rights Campaign that specifically rated LGBTQ client services and support in 2018 HEI participating organizations (n = 626) were compared with the most recent inventory of American Nurses Credentialing Center Magnet health care organizations (n = 477). Results: LGBTQ client services and support HEI scores positively correlated with Magnet status (p = .0002). Discussion: Provision of LGBTQ client services and Magnet recognition is strongly related to higher quality nursing care, suggesting organizations earning Magnet recognition provide more equitable services to its LGBTQ clients.

What Does it Mean to be a Common Factors Informed Family Therapist?

The common factors paradigm in couple and family therapy has gained popularity over the past several decades, leading many therapists to refer to themselves as common factors family therapists. Despite this, no consensus exists on what it means to be a common factors family therapist, or if such a designation even makes sense given that the common factors paradigm is not a model. Synthesizing the existing common factors literature, a case is made for the designation "common factors informed family therapist," and the following six core principles are outlined that characterize this designation: (1) sees overlap among theories; (2) passionate about theory, not a theory; (3) client centered; (4) monitors hope and the therapeutic alliance; (5) views clients as people rather than objects; and (6) prioritizes healing over therapy. Each of the concepts is discussed in depth, and clinical implications are provided.

El paradigma de factores comunes en la terapia de parejas y familiar ha cobrado popularidad en las últimas décadas, haciendo que muchos terapeutas se refieran a sí mismos como terapeutas de factores comunes. A pesar de esto, no hay un consenso acerca de qué significa ser un terapeuta de factores comunes, o si dicha designación realmente tiene sentido, dado que el paradigma de factores comunes no es un modelo. A base de una síntesis de la literatura de factores comunes existente, se aboga por la designación "terapeuta familiar informado por factores comunes", y se esbozan seis principios fundamentales que caracterizan esta designación; 1) ve que las teorías se entrecruzan; 2) apasionado por lo teórico, no por una teoría; 3) centrado en los clientes; 4) está pendiente de la esperanza y la alianza terapéutica; 5) ve a los clientes como personas en vez de objetos; y 6) se preocupa más por la sanación que por la terapia. Se discute cada concepto a profundidad y se proporcionan las implicaciones clínicas.

The relationship between expected engagement and talking therapy outcome.

The aim of the study was to investigate whether client-reported expected engagement with therapy predicted therapy outcome. It was hypothesized that higher expected engagement with cognitive behavioural therapy (CBT) or person-centred experiential therapy (PCET) would predict more symptomatic improvement following therapy and higher likelihood of therapy completion. The Sheffield Expected Engagement with Therapy Scale was administered to 96 clients at pre-therapy assessment with all meeting a diagnosis of moderate or severe depression with 53 receiving CBT and 43 receiving PCET. Higher expected engagement predicted more symptomatic improvement in CBT but not PCET. Expected engagement only predicted improvement in CBT when clients rated the credibility of CBT as low or moderate. Expected engagement did not predict therapy completion in either therapy. Assessment of expected engagement could be a useful tool in prediction of symptomatic improvement in CBT.

Putting the Pieces Together: Perceptions of Longitudinal Wraparound, Systems of Care, and Positive Behavior Support Implementation.

Positive Behavior Support (PBS) was introduced to community-based providers in Kansas in 2012 in response to a federally funded initiative to reduce the placement of youth in psychiatric facilities. As core project activities concluded in 2016, researchers investigated the impact of this comprehensive PBS initiative on youth, families, mental health centers, and other stakeholders. This paper describes how qualitative interviews and focus groups were used to investigate the perceptions of families, advocates, and implementers involved in wraparound (WA), regional interagency collaboration, and the addition of PBS services. Themes reflected the changes occurring over time in statewide WA implementation and how state funding for the PBS effort was used as part of regional interagency collaboration to continue supporting principles outlined in systems of care.

Goal setting dynamics that facilitate or impede a client-centered approach.

BACKGROUND: Client-centred goal setting is central to the process of enabling occupation. Yet, there are multiple barriers to incorporating client-centred goal setting in practice. We sought to determine what might facilitate or impede the formation of client-centred goals in a context highly supportive of client-centred goal setting Methods: We used conversational analysis to examine goal-setting conversations that took place during a pilot trial of Occupational Performance Coaching for stroke survivors. Twelve goal-setting sessions were purposively selected, transcribed, and analyzed according to conventions for conversation analysis. RESULTS: Two main types of interactions were observed: introductory actions and goal selection actions. Introductory actions set the context for goal setting and involved sharing information and seeking clarification related to goal requirements and clients' occupational performance competencies. Goal selection actions were a series of interactions whereby the goals were explored, endorsed or dropped. CONCLUSION: Client-centred occupational performance goals may be facilitated through placing goal-setting in the context of life changes and lifelong development of goals, and through listening to clients' stories. Therapists may improve consistency in adoption of client-suggested goals through clarifying meaning attached to goals and being attuned to power dynamics and underlying values and beliefs around risk and goal attainability.

A survey on client-centered practice among danish occupational therapists.

BACKGROUND: In Denmark, the cost of healthcare services comprise 12% of the gross domestic product. A recommended method for optimizing effectiveness of and enhance client satisfaction with healthcare is client-centred practice (CCP), a central component of occupational therapy ideology. However, Danish occupational therapists' perceptions of CCP, including the facilitators and barriers that may contribute to CCP, have never been examined. AIM: To examine Danish occupational therapists' perceptions of CCP. METHODS: A survey was conducted using an electronic questionnaire in a small, but representative sample of Danish occupational therapists from all regions and practices. RESULTS: Three hundred and forty-six occupational therapists (5%) responded. Of these, 98% rated CCP as important, 97% considered their work client-centred, and 92% were satisfied with their level of CCP. Having time to conduct self-directed work, using assessments to identify clients' priorities, and CCP education, but not fixed regimes, were positively correlated with CCP. CONCLUSION: Danish occupational therapists perceive to practice CCP and appear to have adopted the beliefs, theory and ideals of CCP, perhaps influenced by the egalitarian Danish culture. Self-directed work, means to identify and evaluate their clients' wishes, and education facilitated CCP. Possible absence of occupational therapists not compliant with CCP makes further research warranted.

A naturalistic study exploring mental health outcomes following trauma-focused treatment among diverse survivors of crime and violence.

BACKGROUND: Although considerable research has tested evidence-based practices in clinical trials, research is needed on the use of trauma-focused treatments by victims of crime and violence in naturalistic settings. This study investigated four trauma-focused treatments, prolonged exposure therapy (PE), cognitive behavioral therapy (CBT), eclectic therapy, and person-centered therapy (PCT), and assessed treatment dropout and symptom improvement over five assessment time-points. METHODS: Descriptive comparisons and pattern mixture multigroup growth models were used to assess differences between treatments on time in treatment, rate of dropout, and improvement in posttraumatic stress (PTSD) and depression symptoms in an outpatient sample of 526 clients seeking routine clinical care. RESULTS: PCT was significantly associated with the highest number of therapy sessions completed and the lowest rate of dropout (41.75%) compared to CBT and eclectic treatments. All treatment groups reported PTSD symptom improvement with no significant differences based on therapy type. For depression, the rate of improvement for clients in PCT who dropped out of treatment after session 3 was significantly steeper than the rate of improvement for clients in eclectic treatment who dropped out of treatment after session 3. Clients who stayed in treatment longer generally had larger decreases in symptoms compared to those who dropped out earlier. LIMITATIONS: The small sample size in each of the treatment groups may have limited power to detect change. CONCLUSIONS: Several trauma-focused treatments offered in a community-based setting may result in significant symptomatic improvement.

Results from a person-centered music intervention for individuals living with dementia.

AIM: Dementia is a chronic, costly disease affecting millions of people worldwide. Effective, affordable person-centered interventions are required to improve the lived experiences of individuals with dementia and their caregivers in various care settings. The present study examined the effects of a person-centered music listening intervention on mood, agitation and social engagement for individuals living with dementia. METHODS: This quasi-experimental study was carried out with participants at five community-based adult day health centers (n = 51). Standardized instruments were used to measure mood and agitation, and in-person and video-recorded observations of participant behavior were used to analyze changes before, during and after the intervention across four domains: mood, agitation, connecting to music and engaging socially. Within-person differences were examined using the Wilcoxon signed rank test, and between-group differences were examined using the Mann-Whitney U-test. RESULTS: Although standardized instruments did not yield statistically significant results, the behavioral observations showed a positive change in mood and a decrease in agitation. From pre- to post-intervention, there were statistically significant increases in joy, eye contact, eye movement, being engaged and talkativeness, and a decrease in sleeping and moving or dancing. CONCLUSIONS: Behavioral observations show the positive impact a person-centered music listening intervention might have on individuals living with dementia and attending adult day health centers. This affordable intervention provides a useful tool for caregivers that might improve the day-to-day experience of individuals living with dementia. Geriatr Gerontol Int 2019; 19: 30-34.

A placebo controlled treatment trial of sertraline and interpersonal psychotherapy for postpartum depression.

BACKGROUND: The purpose of the present study was to test the efficacy of sertraline and Interpersonal Psychotherapy (IPT) relative to pill placebo in a two site randomized controlled trial over a period of 12 weeks. It was hypothesized that sertraline and IPT would be more efficacious than pill placebo with respect to depression and social adjustment. METHODS: 162 breastfeeding and non-breastfeeding women experiencing a major depressive episode in the first year postpartum from two sites in Iowa and Rhode Island were randomly assigned to IPT, sertraline-clinical management (CM), or pill placebo-CM. CM included infant-focused psychoeducation. Interview-based and self-report measures of depression and social adjustment were obtained at baseline, 4-weeks, 8-weeks, and 12-weeks of treatment. Linear mixed effects regression (LMER) was used for the longitudinal data analysis. RESULTS: There was no significant effect for treatment condition associated with the primary outcome measure, the HamD-17, but there was a significant effect for sertraline-CM relative to the IPT and placebo conditions over the duration of the trial based on the General Depression scale of the Inventory of Depression and Anxiety Symptoms. There was a main effect for time in that study subjects across all three conditions showed significant improvement for the duration of the trial. LIMITATIONS: Limitations of the present study included significant non-engagement with assigned condition and differential effects of IPT across the two study sites. CONCLUSIONS: There was improvement for all postpartum women in all conditions. The results do suggest that active interventions with or without medication delivered over a period of twelve weeks can lead to significant improvement in depression and social adjustment among postpartum women. ClinicalTrials.gov identifier: NCT00602355.

Effect of adjusting the challenge-skill balance for occupational therapy: study protocol for a randomised controlled trial.

INTRODUCTION: Occupational therapy (OT) is defined as the promotion of client health and well-being through a client-centred practice. However, there is a tendency to rely on the therapist's experiences and values, and there is a difference between the client's and therapist's perceptions regarding the current activity that the client is engaged in. In previous studies that have applied 'flow', activities supported by OT in elderly people were analysed, indicating a difference in recognition. Therefore, we thought that more effective OT could be implemented by adjusting the challenge-skill (ACS) balance, and we invented a novel process termed as ACS balance for OT. The purpose of this study is to verify the effect of ACS-OT on clients in the recovery rehabilitation unit and to prepare a protocol for randomised controlled trial (RCT) implementation. METHOD AND ANALYSIS: This single-blind RCT will recruit 80 clients aged 50-99 years admitted to the recovery rehabilitation unit who meet eligibility criteria. Clients will be randomly allocated to receive ACS-OT or standard OT. Both interventions will be performed during the clients' residence at the unit. The primary outcome measure will be subjective quality of life and will be measured at entry into (pre) and at discharge from (post) the unit and at 3 months afterwards (follow-up). Outcomes will be analysed using a linear mixed model fitted with a maximum likelihood estimation. ETHICS AND DISSEMINATION: This protocol has been approved by the ethics review committee of the Tokyo Metropolitan University (No.17020). Results of this trial will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: UMIN-CTR number, UMIN000029505; Pre-results.

Multi-profile procedures for motor conversion disorders in children - a case report. / Wieloprofilowe postepowanie w konwersyjnych zaburzeniach ruchu u dzieci ­ opis przypadku.

OBJECTIVES: The most common motor deficits in patients with conversion disorder are tremors, weakness of limbsand gait disturbance. The proper diagnosis and treatment aswell as the patient and their family's cooperation during therapy are essential to achieve fast recovery. The aim of this paper is to provide an overview of multidisciplinary interventions successfully applied in the treatment of conversion disorders in children, illustrated with an example of a case study. METHODS: Case report: The 9 years old boy, with trembling of the limbs, trunk ataxia, impaired balance, and significant disability in self-locomotion, caused by conversion disorders, was admitted to stationary rehabilitation treatment because of the lack of progress in the current, four-month treatment, which consisted of hydroxyzin administration and irregular psychotherapy. Behavioural modifications in rehabilitation, individual psychotherapy, family counselling and psychoeducation, and sertralinepharmacologicaltreatmentwereimplemented at the same time. Particular attention was paid to obtain the parents'approval for multidisciplinary therapy, considering that the previous treatment was ineffective because of parents being unconvinced about psychogenic causes of symptoms. They were focused on over diagnosing the child's symptoms making it difficult to manage the proper treatment. RESULTS: After a three-week period of comprehensive treatment the patient recovered completely and returned to independent mobility and social functioning relative to his age. CONCLUSIONS: The simultaneous implementation of multi-profile treatment is an effective approach in children motor conversion disorders. In order to achieve therapeutic success it is necessary to convince the parents about the psychogenic ground of the symptoms and a need of multi-profile treatment.

Adapting psychotherapy to patient reactance level: A meta-analytic review.

Resistance and its extreme variation, reactance, are uniformly observed across varieties of psychotherapy. Social psychologists note that reactant individuals prove to be less so when offered a receptive and nondirective environment. We provide definitions of reactance, review its frequent measures, and offer a clinical example. A meta-analysis of 13 controlled studies (1,208 patients) examined the degree to which treatment outcomes are enhanced when therapists offer less directive treatments to high-reactance patients. The results revealed a large effect size (d = .79), confirming that highly reactant individuals did better in psychotherapy when the therapist assumed a reflective and nondirective stance than a directive and authoritative one. To a lesser degree, the opposite was also true. Limitations of the research and diversity considerations are noted. Practice recommendations are provided to minimize a patient's reactant behavior.

Client feedback in China: A randomized clinical trial in a college counseling center.

Although client feedback has been demonstrated to improve psychotherapy outcomes in over a dozen randomized clinical trials, no studies to date have investigated the feedback effect outside of the United States or Europe. This study examined the impact of a client feedback intervention, the Partners for Change Outcome Management System, in a college counseling center in Wuhan, China (N = 186). Using a randomized design within routine care, treatment as usual (TAU; n = 85) was compared with a feedback condition (n = 101) in which therapists had access to client-generated outcome and alliance information at each session. Clients in the feedback condition demonstrated significantly greater improvement than those in the TAU condition at posttreatment. Not-on-track (n = 60) clients also demonstrated significantly more improvement at 6 times the rate of reliable change compared with the TAU condition. Survival analysis revealed that 66.7% of the clients in the feedback condition achieved reliable and clinically significant change after a median of 4 sessions whereas 57.0% of the clients in the TAU condition achieved reliable and clinically significant change after a median of 6 sessions. Alliance scores improved significantly more across treatment and were higher at posttreatment in the feedback condition. Although preliminary, this study suggests that the positive effects of improved outcomes and increased efficiency associated with systematic client feedback can also occur in a college counseling setting in China. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Implementation of Individualized Music in Long-Term Care: Application of the PARiHS Framework.

The need to provide evidence-based, person-centered care for long-term care (LTC) residents, which often include individuals with dementia, has led to a surge of interest in the implementation of individualized music (IM) programs. An exploratory study was conducted over a 6-month period using the Promoting Action on Research in Health Systems (PARiHS) framework to examine the implementation of an IM program with 19 residents in a LTC facility. All residents using IM had the device available at the end of the program, and 53% received IM at least two times per week. Qualitative analysis of stakeholder interviews with six staff members and three residents after using the PARiHS framework as an implementation guide revealed two themes: Overcoming Resistance to Innovation and Person-Centered Care Through IM. Identification of barriers and facilitators through the PARiHS elements of evidence, context, and facilitation supported the IM implementation process and should enable its replication in other facilities. [Journal of Gerontological Nursing, 44(8), 29-38.].

Effectiveness of Client-Centered "Tune-Ups" on Community Reintegration, Mobility, and Quality of Life After Stroke: A Randomized Controlled Trial.

OBJECTIVE: To explore the effectiveness of a 2-week client-centered rehabilitation intervention (tune-up) delivered 6 months after inpatient discharge on community reintegration at 1 year in people with stroke. DESIGN: A multicenter randomized controlled trial with 2 groups: an intervention ("tune-up") group and a control group having the same exposure to assessment. SETTING: Three research laboratories. PARTICIPANTS: Participants (N=103) with hemiparetic stroke recruited from inpatient rehabilitation units at the time of discharge. INTERVENTIONS: Participants randomized to the tune-up group received 1-hour therapy sessions in their home 3times/wk for 2 weeks at 6 months postdischarge focusing on identified mobility-related goals. A second tune-up was provided at 12 months. MAIN OUTCOME MEASURES: Community reintegration measured by the Subjective Index of Physical and Social Outcome at 12 months and secondary outcomes included the Berg Balance Scale and measures of mobility and health-related quality of life up to 15 months. RESULTS: At 12 months, both groups showed significant improvement in community reintegration (P<.05), a trend evident at all time points, with no difference between groups (mean difference, -0.5; 95% confidence interval, -1.8 to 2.7; P=.68). Similarly, a main effect of time reflected improvement in mobility-related and quality of life outcomes for both groups (P≤.0.5), but no group differences (P≥.30). CONCLUSIONS: All participants in the tune-up group met or exceeded at least 1 mobility-related goal; however, the intervention did not differentially improve community reintegration. The improvements in mobility and quality of life over the 15-month postdischarge period may be secondary to high activity levels in both study groups and exposure to regular assessment.