Turner J, Brown J C, Carpenter D T
Faculty of Health Sciences, University of Southampton, Southampton, UK.
J Psychiatr Ment Health Nurs. 2018 Jun;25(5-6):285-296. doi: 10.1111/jpm.12440. Epub 2018 Jan 30.
There is a move towards the use of new ways of delivering mental health care, particularly via an increased use of telephone therapies. Although some studies have noted the advantages of telephone-delivered therapies (e.g., removing access barriers) and reported on equivalent therapeutic effects when compared to face-to-face, there are concerns about how telephone-based therapy adversely affects the therapeutic relationship.
It contributes new knowledge regarding psychological practitioners' experience and views about using telephone-based therapies and how this affects the therapeutic relationship.
This paper provides data about the new practitioner workforce (IAPT Psychological Wellbeing Practitioners) and adds to a growing area of research regarding their clinical role. It has relevance for mental health nursing, because health services internationally and across the professions are exploring how telehealth can improve health care. This paper suggests that mental health services need to focus on what type of therapeutic relationship their practice facilitates and on offering transparency to service users. It concludes that telephone work in IAPT can accommodate a working alliance, but not other types of therapeutic relationship, which practitioners and service users hoped for. Services need to focus on what facilitates and inhibits deeper therapeutic closeness and connection.
Introduction Over-the-telephone (OTT)-delivered psychological therapies as an alternative method to face-to-face (F2F) are becoming more prevalent in mental health care. Research suggests a range of benefits of OTT use in therapy, but there are growing concerns about its consequences for the therapeutic relationship. This paper presents new knowledge regarding psychological practitioners' experience and views of OTT work and its potential effects on the therapeutic relationship in the context of the UK's Increasing Access to Psychological Therapy (IAPT) programme. Aim This paper presents IAPT practitioners' experiences and views of OTT work and its potential effects on the therapeutic relationship. Methods Completed questionnaires (exploring OTT versus F2F work) which were distributed to IAPT practitioners revealed a concern about the therapeutic relationship in OTT. To explore this further, nine in-depth semi-structured interviews with PWPs were conducted and the findings from this qualitative study are reported here. Results Practitioners noted OTT use facilitated access and flexibility for service users; however, they expressed some concern over the adverse effect of OTT on the therapeutic relationship. Discussion Although a working alliance was possible OTT, this research suggests the type of therapeutic relationship formed OTT in a "low contact-high volume" service such as IAPT needs to be better defined. By addressing this, dissonance which might arise between practitioner aims and the aims of IAPT can be reduced. This research also contributes to wider debates regarding mental health care and its provision in the UK. Implications for practice This paper concludes that mental health services need to focus on what type of therapeutic relationship their practice facilitates and to offer transparency to service users. The findings suggest that telephone work in IAPT can accommodate a working alliance, but not other types of therapeutic relationship, which practitioners and service users hoped for. Services need to offer a more nuanced understanding of the concept of a therapeutic relationship and focus on what facilitates and inhibits deeper therapeutic closeness and connection.
目前正朝着采用新的心理健康护理提供方式发展，尤其是通过增加电话疗法的使用。尽管一些研究指出了电话疗法的优势（例如，消除获取障碍），并报告了与面对面疗法相比具有同等的治疗效果，但人们担心基于电话的疗法会对治疗关系产生不利影响。
它提供了有关心理治疗师使用电话疗法的经验和观点，以及这如何影响治疗关系的新知识。
本文提供了关于新的从业者群体（改善心理状态的心理治疗师）的数据，并增加了关于其临床角色的研究领域。它与心理健康护理相关，因为国际上和各专业的卫生服务机构都在探索远程医疗如何改善医疗保健。本文表明，心理健康服务需要关注其实践所促进的治疗关系类型，并向服务使用者提供透明度。结论是，改善心理状态服务中的电话工作可以容纳工作联盟，但不能容纳从业者和服务使用者所期望的其他类型的治疗关系。服务需要关注促进和抑制更深层次治疗亲密感和联系的因素。
引言 作为面对面治疗的替代方法，通过电话提供心理治疗在心理健康护理中越来越普遍。研究表明，在治疗中使用电话有一系列好处，但人们越来越担心其对治疗关系的影响。本文介绍了在英国增加心理治疗可及性（IAPT）计划背景下，心理治疗师关于电话治疗工作的经验和观点，以及其对治疗关系的潜在影响的新知识。目的 本文介绍IAPT治疗师对电话治疗工作的经验和观点，以及其对治疗关系的潜在影响。方法 向IAPT治疗师发放的完整问卷（探讨电话治疗与面对面治疗工作）显示，他们对电话治疗中的治疗关系感到担忧。为进一步探讨这一问题，对改善心理状态的心理治疗师进行了9次深入的半结构化访谈，并在此报告该定性研究的结果。结果 治疗师指出，使用电话治疗为服务使用者提供了便利和灵活性；然而，他们对电话治疗对治疗关系的不利影响表示了一些担忧。讨论 尽管电话治疗中可能形成工作联盟，但本研究表明，在IAPT这样的“低接触 - 高工作量”服务中，通过电话形成的治疗关系类型需要更好地界定。通过解决这一问题，可以减少治疗师目标与IAPT目标之间可能出现的不一致。本研究也有助于英国关于心理健康护理及其提供的更广泛辩论。对实践的启示 本文得出结论，心理健康服务需要关注其实践所促进的治疗关系类型，并向服务使用者提供透明度。研究结果表明，IAPT中的电话工作可以容纳工作联盟，但不能容纳从业者和服务使用者所期望的其他类型的治疗关系。服务需要对治疗关系的概念提供更细致入微的理解，并关注促进和抑制更深层次治疗亲密感和联系的因素。
