Internet-delivered Cognitive Behaviour Therapy for Depressive Symptoms: An Exploratory Examination of Therapist Behaviours and their Relationship to Outcome and Therapeutic Alliance.

BACKGROUND: A previous study of therapist-assisted Internet-delivered cognitive behaviour therapy (ICBT) for generalized anxiety (Paxling et al., 2013) identified eight distinct therapist behaviours in ICBT (task reinforcement, self-efficacy shaping, task prompting, alliance bolstering, psychoeducation, empathetic utterances, deadline flexibility, and self-disclosure). It is unknown how generalizable these behaviours are across ICBT programs. AIMS: We systematically examined the frequency of these eight therapist behaviours and additional newly identified behaviours in e-mails sent to patients during the course of ICBT for depressive symptoms. We also conducted exploratory analyses to examine relationships between therapist behaviours, symptom improvement, and therapeutic alliance. METHOD: Data was obtained from a previously published open trial (Hadjistavropoulos et al., 2014). A total of 1013 e-mails sent from therapists (n = 24) to patients (n = 41) during ICBT for depressive symptoms were analyzed. Therapist behaviours were correlated with symptom change scores and ratings of therapeutic alliance at mid- and post-treatment. RESULTS: Therapist behaviours described by Paxling et al. were reliably identified in the e-mails using qualitative content analysis; the frequencies of these behaviours differed, however, from the Paxling et al. study and three additional therapist behaviours were identified (administrative statements, questionnaire feedback, asking clarifying questions). Several therapist behaviours (e.g. administrative statements, task prompting) were associated with lower symptom improvement at post-treatment. Questionnaire feedback and task reinforcement were associated with higher patient ratings of therapeutic alliance. CONCLUSIONS: The study provides partial support for the generalizability of therapist-assistance across ICBT programs. Experimental research is needed to examine the impact of varying therapist-assistance on patient outcomes.

A Web of Disheartenment With Hope on the Horizon: Intimate Partner Violence in Rural and Northern Communities.

Intimate partner violence (IPV) has become a worldwide epidemic, yet little is known about the experiences of women survivors living in rural and Northern Canadian communities. Existing statistics suggest that women living in rural areas of the Canadian Prairie Provinces and Northwest Territories (NWT) are at a significantly higher risk of experiencing IPV. To better understand the experiences of IPV in these regions, qualitative interviews were conducted with service providers, including the Royal Canadian Mounted Police (RCMP), Victims Services, Shelter Services, counselors, and others (e.g., physicians). In total, 122 participants were interviewed. These interviews were analyzed using a grounded theory approach where the data/results were transformed into a pictorial matrix that documents the struggles that service providers endure. The matrix/results highlight how social issues, such as isolation and poverty, contribute to social oppressions, such as lack of resources, transportation, and/or services. As service providers struggle against these forces, they begin to develop feelings of disheartenment. Yet, they continue to fight because there are opposing forces, such as Emergency Intervention Orders, police transportation, and Victim Services, that demonstrate how societal response is improving the lives and increasing safety in rural and Northern communities. Ultimately, the results suggest that to reduce the incidences of IPV, we must go beyond the violent acts and deal with the social contexts in which IPV resides.