UNASSIGNED: In psychotherapy, it is important to establish and deepen a therapeutic trusting relationship, but patients who have experienced extreme adversity in childhood tend to have difficulty in building such a relationship. This paper reports a case of fibromyalgia with adverse childhood experiences (ACEs) in which a nonverbal approach was successful in building a trusting relationship.
UNASSIGNED: The patient is a woman in her late 40s. She had strong anger rooted in ACEs, including neglect by her father, a feeling of unfair parenting by her mother compared to her younger brother, overcontrol of her life by her mother, and sexual abuse by her uncle. She was filled with strong interpersonal distrust and anger, and the experience of an unsuccessful surgery compounded her distrust of medical care. The therapist initially had severe difficulty in verbal interaction with the patient. When conducting \"drawing\" therapy, she ignored the therapist\'s comments and completely blacked out the drawing paper. However, the patient-therapist relationship gradually changed, and verbal interaction became possible through the use of nonverbal approaches such as framing her drawing paper and \"Towel Baby Holding.\"
UNASSIGNED: The therapist was able to understand the patient\'s emotions through these nonverbal approaches and to communicate with the patient that she understood her feelings. This approach was also successful in the patient\'s understanding of her own pathology. The patient became able to honestly express her feelings in words, which eventually enabled her to be introduced to mindfulness therapy, leading to a favorable treatment course.
UNASSIGNED: For patients with ACEs, a nonverbal approach helps build a therapeutic relationship and plays an important role in understanding the patient.

The term developmental trauma (DT) refers to the impact of stressful events which occur cumulatively within the child\'s relevant relationships and contexts, and usually early in life. According to several authors, DT depends on the caregiver\'s inadequate intersubjective recognition of one or more aspects of the evolving individual\'s identity. In the clinical and empirical literature, the study of therapists\' developmental trauma, and how it might constitute a relevant variable in the clinical exchange, seem to be underrepresented. In this paper, through the analysis of the supervision process of a clinical case, we show how the therapeutic relationship may implicitly take the form of a \"dance\" between the patient\'s and therapist\'s DT, that prevents the therapist from intersubjectively attuning with the patient; and how a supervision process peculiarly focused on the therapist\'s DT can effectively promote this attunement and a good clinical outcome.

Clinical literature emphasizes how symptoms of psychosis can be efficiently targeted by psychological treatments. The most well-known approach to these symptoms is cognitive-behavioral therapy; but in the last few decades also other approaches are enriching the landscape, focusing on the dysfunctions in mentalization or metacognition, a spectrum of mental activities involving thinking about one\'s own and others\' mental states. This huge amount of theoretical reflection and empirical research focused on the implementation of treatments does not seem to be associated with an attention to the inner world of the therapist who relates to the patient with psychosis; for example, to the impact of the therapist\'s developmental history on the therapeutic relationship. In this paper the authors are inspired by an intersubjective perspective, according to which although the treatment is for the patient\'s benefit, both the patient\'s and the therapist\'s developmental history and psychological organization are equally relevant for understanding the clinical exchange. On this basis, the authors make a \"parallel\" analysis of the clinical case of a young woman with symptoms of psychosis (i.e., persecutory delusions, auditory verbal hallucinations, social withdrawal) and its supervision process. They show how the therapeutic relationship can be significantly conditioned by the therapist\'s developmental history; and how a process of supervision focused on the exploration of the traumatic elements of this history can effectively promote the therapist\'s metacognitive capabilities, a functional patient-therapist intersubjective attunement, and a good clinical outcome.

BACKGROUND: The aim of this study was to explore the therapeutic process between contemporary spiritual healers and their clients in Germany.
METHODS: This prospective observational case study was supported by questionnaires and semi-structured interviews with clients and healers from the first encounter through a period of 6 months. The qualitative analysis is based on a directed content analysis with focus in this article on the results relating to the therapeutic process.
RESULTS: Seven healers and seven clients were included, and 22 interviews with healers and 20 interviews with clients were conducted. The first treatment session was perceived as laying a foundation for the therapeutic process and the relationship, which was seen as crucial for healing to take place. Healers perceived the therapeutic process as highly individualized and multi-layered, with the perceived effects of spiritual healing sessions layered upon each other. The capacities to connect and to trust were seen as key elements of the healing process. Trust and connection operate multidimensionally: to oneself, to others, and to a transcendent or spiritual source. Clients\' spiritual attitudes were regarded as fundamental resources.
CONCLUSIONS: The therapeutic process between spiritual healers and their clients was understood as a dynamic and individual activity, building up on a trustful relationship from the first encounter.
Hintergrund: Ziel dieser Studie war es, den therapeutischen Prozess zwischen zeitgenössischen spirituellen Heilern und ihren Klienten in Deutschland zu untersuchen. Methoden: In dieser prospektiven Fallstudie wurden Fragebögen und semi-strukturierte Interviews mit Klienten und Heilern von der ersten Begegnung und über einen Zeitraum von sechs Monaten erhoben. Die qualitative Analyse basiert auf einer qualitativen Inhaltsanalyse, wobei der Schwerpunkt in diesem Artikel auf den Ergebnissen zum therapeutischen Prozess liegt. Ergebnisse: Es wurden sieben Heiler und sieben Klienten rekrutiert und insgesamt 22 Interviews mit Heilern und 20 Interviews mit Klienten geführt. Die erste Behandlungssitzung wurde als Grundsteinlegung für den therapeutischen Prozess und die Beziehung empfunden, die als entscheidend für die Heilung angesehen wurde. Die Heiler nahmen den therapeutischen Prozess als hochgradig individuell und vielschichtig wahr, wobei die wahrgenommenen Wirkungen der spirituellen Heilsitzungen aufeinander aufbauten. Die Fähigkeit, sich zu verbinden und zu vertrauen, wurde als Schlüsselelement des Heilungsprozesses angesehen. Vertrauen und Verbindung wirken multidimensional: zu sich selbst, zu anderen und zu einer transzendenten oder spirituellen Quelle. Die spirituelle Einstellung der Klienten wurde als grundlegende Ressource betrachtet. Schlussfolgerung: Der therapeutische Prozess zwischen spirituellen Heilern und ihren Klienten wurde dynamisch und individuell verstanden, der von der ersten Begegnung an auf einer vertrauensvollen Beziehung aufbaut.

The purpose of the study was to explore the experiences of an individual navigating life in the first year after stroke, with attention to the influence of health professionals on adjustment.
In-depth interviews were completed at regular intervals with an individual in rural Australia. This longitudinal approach supported the exploration of views over time. Interview transcripts were coded and analysed using strategies consistent with constructivist grounded theory methods. Findings are presented as an instrumental case study.
The experience of stroke was one of adjustment to a new reality and of an altered and evolving concept of self: captured within the themes of fragmentation, loss, and reconstruction. Self-efficacy emerged as a driver in the adjustment process. Interactions with health professionals influenced adjustment and impacted on conceptualisations of self and self-efficacy.
Adjustment to stroke necessitated a reconceptualization of self. Relationships and interactions with others emerged as potential facilitators. For health professionals working with people after stroke, knowledge of the adjustment process and attention to practices that affirm personhood and enhance self-efficacy have the potential to facilitate long term outcomes. Processes linked to adjustment are represented visually to guide conceptual understandings and facilitative actions.
IMPLICATIONS FOR REHABILITATIONAll interactions with health professionals, including casual or ad hoc interactions, have the potential to influence adjustment after stroke.Health professionals who interact in ways that recognise personhood may have an especially positive influence on processes linked to adjustment.Giving time to listen to personal narratives and reflections may assist with sense-making and support the process of reconceptualising self after stroke.Through bidirectional sharing of experience and ideas, health professionals can facilitate the experience of self-efficacy.

This commentary section is based on a comparative analysis of the five articles and case examples presented in this special issue. The place of Case Formulation in the field of psychotherapy is conceptualized as a necessary bridge between diagnostic systems and clinical practice. The common aspects of the five approaches included in the issue, as well as of the cases to which they were applied, are discussed to explore their possible cross-theoretical nature, especially in psychotherapy with more severe cases. All the clients presented in this section have experienced traumas, which manifest themselves as difficulties in their interpersonal relationships. We discuss the value of Case Formulation in the context of clinical practice and research as well as the challenges of fostering the cross-theoretical approach of this tool.

WHAT IS KNOWN ON THE SUBJECT?: There are many international studies on CRHTTs; however, there has been little research on nurses\' experiences of working with CRHTTs. Earlier studies focused on the nurses\' gatekeeping role but did not explore nurses\' perception of care as a construct. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: This study provides information based on mental health nurses\' experiences. It explains the home environment, the therapeutic relationship and the process of mental health nursing care during a crisis. Also, the study explains nurses\' satisfaction with care provided at patients\' home. Unlike other studies, this study focused on nurses\' experiences while providing care, rather than on nurses\' general responsibilities and the services they provide. This study is the first of its kind in Spain with such a focus. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Acknowledging nurses\' experiences and their perspectives about the care they provide could help shift mental health nursing paradigms from those based on biomedical models to newer perspectives found in recovery models. Furthermore, this knowledge could improve the quality of care in mental health settings due to its potential to guide nursing practices. Raising mental health care providers\' awareness of mental health nurses\' personal and professional care constructs would help implement support systems to meet the professional\'s needs. Meeting the needs of nurses related to the care they provide is likely to impact patient care positively.
UNASSIGNED: INTRODUCTION: Crisis resolution home treatment teams (CRHTTs) provide short-term, intensive home treatment to people experiencing mental health crises. There is limited research on nurses\' experiences with CRHTTs. While earlier studies mainly focussed on mental health nurses\' gatekeeping responsibilities, more investigation is needed in this field.
OBJECTIVE: To explore nurses\' perceptions and constructions about care in CRHTT services.
METHODS: A qualitative case study was employed. Ten semi-structured interviews were performed to nursing staff working in CRHTT services.
RESULTS: Three main categories emerged from the data analysis: nurses\' perspectives of the care provided, nursing setting of care at home and nursing care plan at home.
CONCLUSIONS: Findings revealed that nurses experienced greater satisfaction providing care in the home settings, and therefore, it positively impacted the quality of care and reduced patient\'s stigma. This study also relates the value of developing care plans centred on patients\' environments increasing Mental Health Nursing (MHN) work satisfaction.
CONCLUSIONS: Knowledge of the intrinsic experiences of care provided by nurses in CRHTTs may help facilitate the development of the nursing role in CRHTT by improving understanding of care in mental health settings.

Occupational therapy offers support through actuation via a suggested activity. It opens up a differentiated space, a space of experiences where patients can contemplate themselves through play. The therapeutic relationship, assured by the occupational therapist, offers flexibility and malleability to welcome, contain and support the person with an eating disorder. It aims to be compassionate without judgement to favour the experience of movement. \'Making do with oneself\' to \'be with oneself\' while respecting the temporality of the patient\'s possibilities.

OBJECTIVE: The aim of the present paper is to open the discourse regarding the unmet needs of specific patients, especially those with substance use disorder and/or personality disorder where \'multimorbidities\', and/or \'overdiagnosis\' and/or \'diagnosis overlap\' are frequent. An additional aim is to review the main therapeutic purpose and concepts of Gestalt therapy which might be appropriate in the treatment of these patients often characterized by their difficulties in being aware and in contact in the \'here and now\'.
METHODS: I first start with an overview of Gestalt therapy concepts. Then, I illustrate Gestalt\'s \'here and now\' and awareness concepts applied during 18 sessions with an inpatient diagnosed with substance use and bipolar disorders. In addition, the patient had to face an open criminal charge, was regarded as having an antisocial personality disorder and argued suffering from post-traumatic stress disorder.
RESULTS: After this two-month therapy period, the patient entered for the first time a daily rehabilitation program in the community, where he was doing well (this after a few prior hospitalizations). The awareness development in the \'here and now\' through which different contact styles and cycles of experiences are experienced is a process that allowed the patient to start experiencing contact with himself, his true needs and his environment. This contributed to his well-being improvement, led and supported his rehabilitation and reinsertion within the society and decrease his relapses, either with drugs or criminal activities. Copyright © 2016 John Wiley & Sons, Ltd.
CONCLUSIONS: People with substance use disorder (where \'multimorbidities\', \'overdiagnosis\' or \'diagnosis overlap\' are frequent), people with personality disorder(s) or people who have difficulties in defining what really disturbs them are the same people who could benefit of GT encouraging awareness and contact development in the \'here and now\'. Gestalt therapy should not be regarded as a practitioner\'s toolbox but as a therapeutic process allowing awareness and I-boundaries development in the \'here and now\' through authentic and genuine relationships. The therapist\'s awareness and contact with themselves and their environment are reflected in the therapist\'s relaxed but awake and aware state of mind as well as their wise, spontaneous and mindful approach.

Holistic treatment during a first episode psychosis (FEP) can significantly impact the longevity and chronicity of the illness, as well as reduce the risk of premature death by suicide. However, treatment can only be effective if the young person participates. Given that 19-40% of young people disengage from early intervention services for FEP, this qualitative study aimed to understand how young people experienced engagement with case managers at an early intervention service. Semistructured interviews were conducted with seven young people and themes were identified using interpretive phenomenological analysis. Young people detailed how engagement with a service could be viewed as a process, following different stages between initial referral and discharge. Throughout this process, a number of factors influenced young people\'s decision to engage with, or disengage from, their case manager. This created a push-pull dynamic with periods of good engagement and poor engagement. Discussion of this dynamic adds nuance to established scholarship about engagement, including shifts over time in the importance of client empowerment and valued features of therapeutic relationships. Awareness and understanding of these concepts may guide changes to early intervention services and address the core issue of engagement.