Madam, lack of attention leads to tension. Approaches are reading of thoughts before executing, analyze and think over on its causes of raising, make a plan how to execute and think the effects before talk and in action. Observation of thoughts is one of the major approach. Set right of thought with good and accurate knowledge. Execution in a smooth way or according to the need of time. Through these major approach we can handle the tension very easily.

Mojgan:

To give you a general sense of the study, here is the summary from the grant:

Over 1 million Canadians use psychotherapy each year to alleviate their mental health problems. Psychotherapy is highly efficacious, and several therapeutic approaches are equally effective (cognitive, interpersonal, psychodynamic) for common disorders (depression, anxiety). Common therapy factors like establishing a therapeutic alliance are related to positive patient outcomes. However, there is a well-documented gap between practice and research in psychotherapy. To address this gap, we developed the Psychotherapy Practice Research Network (PPRNet; www.pprnet.ca) to engage therapists and researchers in practice-based patient-oriented research. PPRNet initiated a deliberative priority setting process in which over 1000 therapists ranked their top research priorities that included: (1) identifying and repairing therapeutic alliance tensions, and (2) professional development. This proposal is the next step of this collaborative process. Therapeutic alliance is one of the most researched and important therapist practices that is robustly related to patient outcomes across all psychotherapy modalities. Tensions in the alliance (breakdowns in the collaborative relationship between patient and therapist) are reliably associated with poor patient outcomes. OBJECTIVE: to evaluate the effectiveness of professional development training designed to improve therapists’ skills to detect and repair alliance tensions. OUTPUTS: (1) training will increase therapist competence to detect and repair alliance tensions; and (2) increased therapist competence will improve patient mental health outcomes. HYPOTHESES: compared to therapists in the control condition who receive no intervention, therapists who do receive the professional development intervention will: (1) show greater competence in detecting and repairing alliance tensions; (2) have patients who experience better outcomes; (3) report greater self-efficacy in detecting and repairing alliance tensions; and (4) have greater increase in patient and therapist reported alliance during psychotherapy. This study will use a cluster randomized trial design, with patients clustered within therapists. Therapists will be assigned to study condition with 1-1 allocation to compare: (1) therapists (n = 40) who receive a professional development intervention to identify and repair alliance tensions to (2) therapists (n = 40) who do not receive the intervention. Therapists will each recruit 7 new patients that will be seen for at least 6 psychotherapy sessions (N = 560 patients). Therapists’ competence in identifying and repairing alliance tensions will be assessed by reliable trained blind judges using a valid observer-based rating system to assess audio recordings of the psychotherapy sessions. Patient outcomes will be assessed by patient and therapist self-report at baseline, post-study period, and at follow-up. Knowledge translation will be informed by qualitative analysis of post-study interviews with therapists, and knowledge dissemination will be facilitated by our existing network of therapists. Our team represents Canada’s leaders in psychotherapy research and training. Co-applicants developed the evidence-based learning modules to identify and repair alliance tensions. Research to improve practicing therapists’ ability to identify and repair therapeutic alliance ruptures will result in better mental health outcomes for the many Canadians who seek psychotherapy each year.

As for the actual therapist training, here is a summary:

The professional development

intervention is an educational program constructed on evidence-based methods, which was developed

and published by members of our team (Ravitz & Leszcz). The intervention teaches therapists to

make the most of psychotherapeutic relationships, including: methods to successfully form an alliance,

using meta-communication, mentalizing, and identifying and repairing alliance tensions. Alliance

tensions may be detected when there is a disagreement on tasks or goals of psychotherapy or there is a

strain in the relational bond between therapist and patient. Interventions to repair tensions include:

repeating the therapeutic rationale, changing tasks or goals, clarifying misunderstandings, or exploring

relational themes.

The professional development consists of case-based descriptions and DVDs

with role plays by experts and standardized patients. These are state of the art methods of education

practice based on quality evidence and recommendations from systematic Cochrane Reviews. We

will conduct 2 separate 2-day workshops for therapists randomized to this condition. The workshops

will occur prior to therapists recruiting patients. Following the workshop and after the therapists enroll

their first patient, the therapist will attend monthly 2-hour virtual or face to face supervision meetings

with up to 10 therapists at a time and led by one of the trainers. Therapists will end supervision when their patients complete the trial (if necessary,

number of supervisions attended may be controlled in the analyses). Independent reliable trained judges

will rate audio recordings of each psychotherapy session for alliance tensions and repairs. These

ratings will be used by the supervisor/trainer to focus the supervision meetings, to provide feedback to

therapists, and to ensure adherence/fidelity to the model.

I hope this gives you the information you were seeking.

Best wishes,

John

I think that this question is a very important one and agree with your point that understanding alliance ruptures and how to repair them will vary substantially depending on the particular patient's problems, needs, and goals. This line of thinking is reviewed and developed in this attached paper.