Motivation, Rapport, and Resilience: Three Pillars of Adolescent Therapy to Shift the Focus to Adulthood

Purpose The purpose of this clinical focus article is to encourage speech-language pathologists (SLPs) to shift their operational framework as students grow from childhood to adulthood by focusing on three pillars of interaction: motivation, rapport, and resilience. We need to foster greater independence and interpersonal skills in older students, but researchers have not explained how to help SLPs successfully transition their intervention strategies. Here, we identify three pillars of adolescent therapy—motivation, rapport, and resilience—to help clinicians shift their perspective from childhood to adulthood. We rely on social constructivism to guide practice and argue that client-centered models of therapy are more appropriate than therapist-centered models for adolescent students. For each pillar, we discuss clinician behaviors, student results, and clinical implications. Conclusions By strengthening these three pillars of interaction, clinicians can shift their focus toward client-centered therapy models and facilitate skills students need in adulthood. Strengthening skills related to motivation, rapport, and resilience will help support more symmetrical and flexible clinical partnerships in adolescent students with communication disorders.

FOSTERING PROSOCIAL BEHAVIOURS OF EARLY CHILDHOOD THROUGH GROUP GUIDANCE WITH A CLIENT CENTERED THERAPY APPROACH

This study aims to see how group guidance with a client-centred therapy approach in early childhood improves prosocial behaviour. This study uses library research method. Data analysis in this study used a narrative synthesis analysis. The results of this study indicate that prosocial behaviour is behaviour that is displayed when interacting with other people where children spontaneously help others. Prosocial behaviour is displayed by early childhood to the friends, parents, teachers and the surrounding community. Group guidance with a client-centred therapy approach provides counselling techniques to make early childhood become individuals who can understand their potential and actualize their social relationships. In the implementation of group guidance, early childhood will interact and communicate with each other; the counsellor can ask them to practice these prosocial behaviours. Either by answering questions if (...) then (...) or by telling how he should act when faced with a situation that requires displaying this prosocial behaviour.

FOSTERING PROSOCIAL BEHAVIOURS OF EARLY CHILDHOOD THROUGH GROUP GUIDANCE WITH A CLIENT CENTERED THERAPY APPROACH

This study aims to see how group guidance with a client-centred therapy approach in early childhood improves prosocial behaviour. This study uses library research method. Data analysis in this study used a narrative synthesis analysis. The results of this study indicate that prosocial behaviour is behaviour that is displayed when interacting with other people where children spontaneously help others. Prosocial behaviour is displayed by early childhood to the friends, parents, teachers and the surrounding community. Group guidance with a client-centred therapy approach provides counselling techniques to make early childhood become individuals who can understand their potential and actualize their social relationships. In the implementation of group guidance, early childhood will interact and communicate with each other; the counsellor can ask them to practice these prosocial behaviours. Either by answering questions if (...) then (...) or by telling how he should act when faced with a situation that requires displaying this prosocial behaviour.

BIMBINGAN KONSELOR BAGI ORANG TUA ANGKAT ANAK TERLANTAR ANAK TERLANTAR (STUDI KASUS DI DINAS SOSIAL KOTA BANDAR LAMPUNG)

Bimbingan konselor adalah salah satu cara yang dilakukan pemerintah dalam pemberian bantuan kepada calon orang tua angkat yang akan mengangkat anak dengan cara berdialog, memberikan motivasi untuk menemukan jalan keluar dan mencapai tujuan yang diinginkan Penelitian ini dilakukan karena dilatarbelakangi oleh banyaknya masalah yang timbul saat proses pengangkatan anak dan masalah pribadi yang dihadapi oleh orang tua angkat saat mengangkat anak. Tujuan adanya bimbingan bagi orang tua angkat adalah untuk membantu orang tua angkat dalam menghadapi masalah yang timbul ketika proses pengangkatan anak dan masalah pribadi yang dihadapi oleh orang tua angkat saat mengangkat anak dan sesudah mengangkat anak. Penelitian ini merupakan penelitian kualitatif. Dalam pengumpulan data, penulis menggunakan metode wawancara, observasi, dan dokumentasi. Sampel dalam penelitian ini berjumlah 7 orang dengan rincian 4 pasang orang tua angkat anak terlantar dan 3 konselor. Sedangkan yang menjadi objek penelitian adalah pelaksanaan Bimbingan Konselor Bagi Orang Tua Angkat Anak Terlantar dan Apa metode yang digunakan konselor dalam melakukan bimbingan bagi orang tua angkat . adapun analisis data yang digunakan adalah analisis deskriptif. Hasil penelitian bahwa pelaksanaan bimbingan konselor bagi orang tua angkat yang dilakukan konselor di Dinas Sosial Kota Bandar Lampung adalah dengan menggunakan metode langsung dengan teknik individual atau teknik kelompok dengan pendekatan Client-Centered Therapy yang melalui beberapa tahapan dalam bimbingan yaitu tahap penyululuhan, konsultasi, konseling, pendapingan dan pelatihan. Teknik individu dengan menggunakan bimbingan individu dan pendekatan Client-Centered Therapy. Dengan tujuan untuk membuka cara berfikir klien untuk mencapai realisasi diri yang optimal. Dengan adanya pelaksanaan bimbingan konselor dan diberikannya metode Client-Centered Therapy kepada orang tua angkat hal ini juga memberikan pengaruh baik kepada anak angkat dengan menjadikan anak angkat menjadi anak yang mandiri, percaya diri, sabar dan berkepribadian baik kepada orang tua dan masyarakat sekitarnya.

Psychological Formulation, a Critical Viewpoint: Illness Ideology in Disguise

Recent years have seen a surge of interest by clinical psychologists in the idea of psychological formulation. Interest in this idea has also been shown by humanistic psychologists as evidenced by a recent issue of this journal, in which formulation is offered as a possible antidote to diagnosis. In this article, I examine the idea of formulation from the viewpoint of client-centered therapy, offering a critical perspective and concluding that as formulation is ultimately about identifying a specific pathway for a specific problem, it continues to subtly promote a medical ideology, incompatible with client-centered therapy.

Da Ludoterapia Não-Diretiva à Ludoterapia Centrada na Criança –Desenvolvimento Histórico

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. Palavras-chave : Humanistic psychology; Client centered therapy; Child psychotherapy; Play therapy.

First Encounters in Psychotherapy: Relationship-Building and the Pursuit of Institutional Goals

This article examines how therapists and patients start building and managing relationships and pursue institutional goals at the same time. Based on a corpus of 6 audio-recorded therapies (client-centered therapy and psychodynamic therapy), I investigate first encounters between therapists and patients as the starting points of any therapeutical process and the place where a relationship between the interactants is established for the first time. Following a microlinguistic qualitative approach and applying methods from conversation analysis and discourse analysis, I show how therapists, on the one hand, try to align with patients to build a positive working alliance and, on the other hand, work to fulfill specific interactive tasks of therapeutic discourse which demand disaligning with the patients’ communicative activity and their interactive expectations. Specific interactive “jobs” that need to be fulfilled in psychotherapy are identified, namely the performance of institutional roles by the interactants, the establishment of an interaction structure and the pursuit of helpful change in the patient. I show at which places in the interaction therapists (dis-)align with the patients’ projected communicative activity and how aligning and disaligning are related to the interactive process and the establishment and performance of these interactive jobs. The analysis shows that, at the beginning of therapy, alignment and disalignment are both important processes for the following reasons: Aligning with the patient contributes to a positive relationship, which has been shown to be vital for successful psychotherapy, while disaligning introduces the patient to the specific discursive mechanisms that characterize therapeutic discourse and constitute the basis for its effectiveness. Overall, the paper argues that reducing therapy to a dichotomy between relationship and “technique” seems overly simplistic, as both aspects need to be handled and managed at the same time.

Decreased Hospitalizations and Improved Health-Related Outcomes Using Client-Centered Therapy in Adults with Sickle Cell Disease with High Health Care Utilization

Background:Sickle cell disease (SCD) is a chronic multisystem disorder associated with vaso-occlusive pain and organ damage, leading to substantial morbidity, impaired health-related quality of life, increased health care costs, and a high risk of premature death (Platt el al. N Engl J Med. 1994). SCD complications and pain episodes accounted for 23% of statewide admissions, mainly by a small group of high utilizers. (Woods et al. Public Health Rep, 1997). Adults with SCD have a high rate of depression, 35% compared to 6.7% in the general adult population (Adam, Flahiff, Kamble, et al. 2017). Chronic persistent pain occurs in more than a third of adults with SCD. Opioid analgesics, the mainstay for the management of acute and chronic pain, often results in opiate use disorder (Ehrentraut et al. J Pediatr Psychol. 2014). Current clinical approaches to address depressive symptoms in SCD have not been effective due to the gaps in care and barriers to access healthcare resources. Client-centered (or person-centered) therapy, is a non-directive approach to counseling that incorporates the concepts of unconditional positive regard, empathetic understanding, genuine affect, and culturally responsive care to improve psychosocial outcomes (Meyer & Zane, 2018). We sought to address these perceived gaps in care using client-centered therapy to improve patient related health outcomes in a cohort of adult patient who were high utilizers. Methods:The study sample comprised 9 patients with SCD (HbSS and SC), ages 23-42, who followed with the adult SCD Clinic at Vanderbilt University Medical Center in Nashville, TN. This cohort of patients was selected as they accounted for the highest health care utilization in our adult program. Demographics and baseline clinic data were obtained on each participant, including pre- and post-measures for hospitalizations, oral morphine equivalent (OME), PHQ-9 to measure depressive symptoms, and the Working Alliance Inventory (WAI), to measure the effectiveness of the client-centered approach to therapy (based on consensus of goals, confidence in and commitment to helping relationship, and mutual trust). Our approach to evaluations is depicted in Figure. Exclusion criteria included current diagnosis of psychosis or a comorbid disorder with psychosis as defined by the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition); active suicidal/homicidal ideation, and unwillingness to participate in counseling. Patients were expected to attend 7 individual sessions for 60 minutes each with a trained mental health clinician. Clinical and laboratory data was obtained through electronic medical record under an IRB approved protocol. Results:In our sample, 5/9 (56%) of our patients were male and they were all African Americans. Eight out of 9 participants had HbSS and 1 had HbSC. The median age of all participants was 30 years. The participants completed a combined total of 64 sessions over an average of 6.7 months. All participants completed an average of 7 sessions each. The average number of hospitalizations pre-intervention per participant was 3 and decreased to 1 post-intervention. The pre and post OME totals for 6/9 participants remained stable. One participant (#8) had a 50% decrease in OME, and two participants (#2, #3) had an increase in total OME post-intervention associated with pregnancy-related complications. Pre-intervention, 69% of participants identified mild to moderate severity in depressive symptoms. The total PHQ-9 scores decreased post-intervention by 3 points, or by 4.4%. The WAI average post-intervention depicts an average of 87.5% of participants identified a strong working alliance with their therapist (Table). Conclusion:Our pilot study shows that client-centered therapy is a safe and effective approach to address age-dependent chronic health challenges of adults with SCD. Client-centered therapy decreased hospitalization rates and PHQ-9 scores for our high utilizers. Though there was not a statistically significant decrease in participants' OME, 67% of the sample remained stable, without an OME increase during the intervention period. Future research and longer-term studies are needed on utilizing this approach to address coping mechanisms, baseline stress levels, and overall quality of life in a larger cohort of adults with SCD. Disclosures No relevant conflicts of interest to declare.