Mandated Treatment and Its Impact on Therapeutic Process and Outcome Factors
In conclusion, treatment outcomes in different domains seem to be linked to the client’s motivation to attend treatment and the feeling of being coerced into therapy, regardless of mandate (2). It has been argued that there is, potentially, an element of coercion in every clinical encounter (80) and the perception of coercion has a variety of determinants, many of which are dependent on the quality of relationship with the service provider (45). Therefore, reducing feelings of coercion might improve treatment outcomes, prevent disengagement from services, and ameliorate therapeutic relationships (5). Facilitating the integration of extrinsic motivation through participatory decision making and interpersonal contexts of relatedness and security produces maintained change (52). Service providers should therefore be encouraged to find the right balance between control and flexibility (70): A dual-role relationship (“firm but fair”) can help to motivate offenders to engage and stay in therapy (55) and reduce offending behavior (34, 35), despite lack of motivation and possible high symptom load. In this regard, the more consistent and longer attendance due to legal framework with provision of supportive aftercare (70) can enable motivational interventions and strengthen therapeutic relationships.Author ContributionsHH and TV wrote the initial article, and CH revised the paper critically for important intellectual content.Conflict of Interest StatementThe authors ...
Authors: Dutra JDM, Lisboa QC, Ferolla SM, Carvalho CMML, Mendes CCM, Ferrari TCA, Couto CA Abstract Some epidemiological evidence suggests an inverse correlation between non-alcoholic fatty liver disease (NAFLD) frequency and vitamin D levels. Likewise, a beneficial effect of vitamin D on diabetes mellitus (DM) and insulin resistance has been observed, but this is an unsolved issue. Thus, we aimed to investigate the prevalence of hypovitaminosis D in a NAFLD Brazilian population and its association with disease severity and presence of comorbidities. In a cross-sectional study, the clinical, biochemical and histo...
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