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Trauma Healing With The Neurosequential Model Of Therapy And Bal-A-Vis-X, Becky Johnston May 2022

Trauma Healing With The Neurosequential Model Of Therapy And Bal-A-Vis-X, Becky Johnston

Educational Specialist, 2020-current

Stigma related to childhood trauma is shifting with the help of advancements in the understanding of neurobiology and interventions that are proving to be effective for healing. There are immense costs and consequences for survivors of childhood trauma and their loved ones that were not so long ago considered irrelevant and the notion that kids bounce back from adversity was previously popular in the psychological community (Perry & Szalavitz, 2017). The broad strokes of Dr. Bruce Perry’s clinical intervention model, The Neurosequential Model of Therapy (NMT) describes a trauma-sensitive, sequential approach to changing the stress response within mental health counseling. …


Writing While Black: African American Vernacular English (Aave) And Perceived Writing Performance, Jaylin N. Nesbitt May 2022

Writing While Black: African American Vernacular English (Aave) And Perceived Writing Performance, Jaylin N. Nesbitt

Masters Theses, 2020-current

In the education system, there have historically been inequities that have severely disadvantaged Black students academically. One area in which these inequities surface is on writing assessments in the form of lower scores. I argue that because the U.S. education system is centered around Standard American English (SAE), it disadvantages those from different linguistic backgrounds, specifically Black students, as they are most likely to be speakers of African American Vernacular English (AAVE). Although there are theoretical justifications for this, past literature has not empirically tied inequities on writing assessments to Black students’ use of AAVE. The current study used Natural …


An Examination Of Working Memory In Subtle And Mild Cognitive Impairment, Kara Eversole May 2022

An Examination Of Working Memory In Subtle And Mild Cognitive Impairment, Kara Eversole

Masters Theses, 2020-current

Mild cognitive impairment (MCI) is abnormal cognitive decline that may be indicative of an insidious process such as dementia. Individuals with MCI are largely independent in their daily functioning but are at risk of further decline. To more deeply understand the working memory deficits associated with age-related cognitive decline, Lamar and colleagues developed a working memory task with no discontinuation rule: the Backwards Digit Task (BDT). Prior BDT research has demonstrated that individuals with mild cognitive impairment have lower overall scores on this task, and that different subtypes of MCI are more prone to certain errors. Research has not been …


The Relationship Between Therapist Adverse Childhood Experiences, Personal Therapy, Resilience, And Treatment Outcomes, Elizabeth J. Nunez May 2022

The Relationship Between Therapist Adverse Childhood Experiences, Personal Therapy, Resilience, And Treatment Outcomes, Elizabeth J. Nunez

Doctor of Psychology (PsyD)

With the development of the Adverse Childhood Experiences (ACE) questionnaire, Felitti et al. (1998) established that childhood trauma has a wide-ranging impact on adult health. Subsequent studies have identified a myriad of relationships between childhood adversity and negative physical, psychological, social, vocational, educational, and developmental outcomes in adulthood (Centers for Disease Control and Prevention, 2020; Hughes et al., 2017; Kalmakis & Chandler, 2015). New research has uncovered higher rates of ACEs among those in helping professions (Butler et al., 2018; Harris, 2019; Thomas, 2016), but it is unclear how these experiences impact their work as helpers. This study investigated the …


Covid‑Specific Coercive Control Among Emerging Adults Attending College: A Brief Note, Heather Littleton, Katie Edwards, Kayla E. Sall, Stephanie Lim, Victoria Mauer May 2022

Covid‑Specific Coercive Control Among Emerging Adults Attending College: A Brief Note, Heather Littleton, Katie Edwards, Kayla E. Sall, Stephanie Lim, Victoria Mauer

Department of Psychology: Faculty Publications

The COVID-19 pandemic represents a “perfect storm” with regards to risk for intimate partner violence (IPV). Abusive partners may engage in novel forms of coercive control, such as pressuring their partner to engage in activities associated with COVID-19 infection risk (e.g., attend a large gathering). However, no empirical research has focused on COVIDspecific coercive control. The current study sought to evaluate the prevalence of COVID-specific coercive control in a large sample of U.S. college students, as well as its association with other forms of IPV and depression and anxiety. A total of 2,289 undergraduate students attending eight U.S. universities who …


Can Technology Reduce The Stress Of The Child Welfare Practitioner?, Quality Improvement Center For Workforce Development May 2022

Can Technology Reduce The Stress Of The Child Welfare Practitioner?, Quality Improvement Center For Workforce Development

Other QIC-WD Products

Information and communication technology (ICT) “has the potential to dramatically shift and enhance social work practice,” according to Berzin, Singer, & Chan (2015). ICT includes tools that allow users to both communicate with colleagues and clients and access, store, transmit, and manipulate information (Perron et al., 2010). Such technology integration can create practices that are more flexible, on-demand, and individualized not only to the families served, but also to the practitioner. Mobile technology, as well as other technologies (e.g., gaming, social media, robotics, wearable technologies) will enhance practice gains and result in more timely, accurate, and targeted services (Berzin, Singer, …


Assessing Your Workforce Needs, Quality Improvement Center For Workforce Development May 2022

Assessing Your Workforce Needs, Quality Improvement Center For Workforce Development

Other QIC-WD Products

You know you have a workforce challenge… but do you know what is causing it? Many child welfare agencies have expanded recruitment efforts through social media, started using telework and flexible work schedules, and even increased wages and provided hazard pay to build and strengthen their child welfare workforce. But sometimes even the best strategies don’t fix the problem because they aren’t aligned with the underlying cause of the problem. When your child welfare workforce is understaffed or overwhelmed it is tempting to want to find an immediate fix because the need to expand the workforce is urgent. However, it …


The Relationship Between The Contrast Avoidance Model And Dysfunctions Of Generalized Anxiety Disorder, Whitney S. Shepherd May 2022

The Relationship Between The Contrast Avoidance Model And Dysfunctions Of Generalized Anxiety Disorder, Whitney S. Shepherd

Honors Theses

Generalized Anxiety Disorder (GAD) features excessive worry, with additional symptoms including sleep disturbances, muscle tension, concentration issues, fatigue, and irritability (APA, 2013). The Contrast Avoidance Model (CAM) posits that those with GAD maintain worry to avoid emotional shifts by engaging in contrast avoidance (CA) tendencies (Newman & Llera, 2011). Additionally, chronic worry is associated with dysfunctional outcomes of GAD such as sleep difficulties and quality of life (QoL; Henning et al., 2007; Smith et al., 2000). Although both CA tendencies and these dysfunctional outcomes of GAD have shown to be related to worry, CA tendencies have yet to be explored …


Organizational Change Process Milwaukee - Needs Assessment Summary, Quality Improvement Center For Workforce Development May 2022

Organizational Change Process Milwaukee - Needs Assessment Summary, Quality Improvement Center For Workforce Development

Other QIC-WD Products

Exploration of Needs

The Quality Improvement Center for Workforce Development (QIC-WD) worked with the Division of Milwaukee Child Protective Services (DMCPS) to conduct a needs assessment. A variety of information was explored to learn about the current workforce and the agency’s workforce practices, including 1) recruitment, hiring, and retention metrics and processes, 2) organizational culture and climate, and 3) other workforce processes and initiatives, such as onboarding, mentoring, supervision, performance management, and employee recognition. More specifically, four major types of information were considered: 1) objective data from various agency databases and reports; 2) subjective perceptions of staff and supervisors, …


Onboarding Program Eastern Band Of Cherokee Indians - Needs Assessment Summary, Quality Improvement Center For Workforce Development May 2022

Onboarding Program Eastern Band Of Cherokee Indians - Needs Assessment Summary, Quality Improvement Center For Workforce Development

Other QIC-WD Products

Exploration of Needs

The Quality Improvement Center for Workforce Development (QIC-WD) worked with the Eastern Band of Cherokee Indians Family Safety Program (FSP) to conduct a needs assessment. A variety of information was explored to learn about the current workforce and the agency’s child welfare workforce practices, including 1) recruitment, hiring, and retention metrics and processes, 2) organizational culture and climate, and 3) other workforce processes and initiatives, such as onboarding, mentoring, supervision, performance management, and employee recognition. More specifically, four major types of information were considered: 1) objective administrative data; 2) subjective perceptions of staff and supervisors, gathered …


Competency-Based Personnel Selection Oklahoma - Needs Assessment Summary, Quality Improvement Center For Workforce Development May 2022

Competency-Based Personnel Selection Oklahoma - Needs Assessment Summary, Quality Improvement Center For Workforce Development

Other QIC-WD Products

Exploration of Needs

The Quality Improvement Center for Workforce Development (QIC-WD) worked with the Oklahoma Department of Human Services (DHS) to conduct a needs assessment. A variety of information was explored to learn about the current workforce and the agency’s child welfare workforce practices, including:

  1. recruitment, hiring, and retention metrics and processes,
  2. organizational culture and climate, and
  3. other workforce processes and initiatives, such as onboarding, mentoring, supervision, performance management, training, and employee recognition.

More specifically, four major types of information were considered: 1) objective data from various agency databases and reports; 2) subjective perceptions of staff and supervisors, gathered …


The Impact Of Covid-19 And Telehealth Services On Attrition Rates In Psychotherapy, Rylan B. Hellstern May 2022

The Impact Of Covid-19 And Telehealth Services On Attrition Rates In Psychotherapy, Rylan B. Hellstern

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

Clinicians in psychotherapy are constantly looking at their outcomes in order to identify and remove barriers that may inhibit effective treatment. Defined generally as the ending of a treatment prior to proper optimal benefit, attrition has been found to both hinder treatment efficacy and cost-effectiveness in therapy. While most attrition literature focuses on the contributing factors to such premature termination, little to no research is available that discusses potential resources for attrition rates. The COVID-19 pandemic has resulted in the use of telehealth services which may serve as a resource to combat attrition. The current study aims to identify how …


A Randomized Controlled Trial On Using Peer-Support Coaching To Improve Adherence To Online Self-Help For College Mental Health, Korena S. Klimczak May 2022

A Randomized Controlled Trial On Using Peer-Support Coaching To Improve Adherence To Online Self-Help For College Mental Health, Korena S. Klimczak

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

Online self-help programs can serve as accessible mental health resources, allowing users to learn skills for improving their mental health at their own pace. The self-guided nature of these programs allows them to be cost-efficient as compared to traditional therapy and appealing to those who do not want to attend traditional therapy due to stigma or low-perceived need. However, these programs also struggle with low adherence rates, with typically only a small subset of users completing a given program in full. Coaching has been previously explored as a way to increase program adherence, adding a low-intensity human component to self-help …


The Impact Of Implicit Bias On The Overdiagnosis Of Schizophrenia, Ace Ogbebor May 2022

The Impact Of Implicit Bias On The Overdiagnosis Of Schizophrenia, Ace Ogbebor

Electronic Theses, Projects, and Dissertations

According to the American Psychiatric Association (2017), Black Americans are more likely to be diagnosed with schizophrenia and less likely to be diagnosed with a mood disorder in compassion to their White counterparts presenting with the same symptoms. To address mechanisms of implicit bias and the implications for mental health practice, it is imperative to investigate the diagnostic process of students who will enter the field of mental health.

According to the Council on Social Work Education, 80% of MSW graduates work in positions providing micro-level direct service to individuals, families, and groups (CSWE, 2019). Moreover, 80% of MSW graduates …


Social Work Students' Understanding Of Childhood Psycho-Emotional Maltreatment By Caregivers, Todd M. Rubin May 2022

Social Work Students' Understanding Of Childhood Psycho-Emotional Maltreatment By Caregivers, Todd M. Rubin

Electronic Theses, Projects, and Dissertations

Child psychological, emotional maltreatment (CPEM) presents to the social work profession as one of the most challenging to detect, prevent and intervene. The consequences of CPEM have been equally devastating to a child’s development compared to all other forms of childhood maltreatment. The purpose of this study is to assess graduate social work students’ knowledge of CPEM as a determinant of their clinical preparedness to work with families in practice. The rationale for this study is to explore how the lack of focus on CPEM in university education, field experience, and field supervision impacts a social worker’s ability to prioritize …


Practicing Trauma-Informed Care In Nursing For A Better Outcome In Hospitalized Adolescents With Adverse Childhood Experiences And Trauma, Allysa Mia Fabricante May 2022

Practicing Trauma-Informed Care In Nursing For A Better Outcome In Hospitalized Adolescents With Adverse Childhood Experiences And Trauma, Allysa Mia Fabricante

Nursing | Senior Theses

As nurses we want to give our patients the best care. That is why trauma-informed care (TIC) is important to include into nursing practice. TIC is a fairly new idea that addresses a patient's whole past and present life. Incorporating it into nursing practice can benefit patients who have adverse childhood experiences and trauma. Adverse Childhood Experiences (ACEs) are traumatic events that occur to a person starting from birth to 17 years old. In a hospital setting an adolescent patient can be triggered if ACEs and trauma is not properly addressed. The long-term effects of ACEs can affect adolescents into …


Adolescent Dating Violence: Attachment Style And Parents' Unhealthy Marital Relationship As Possible Predictors, Karli Spann May 2022

Adolescent Dating Violence: Attachment Style And Parents' Unhealthy Marital Relationship As Possible Predictors, Karli Spann

Psychological Science Undergraduate Honors Theses

This study tests whether insecure attachment style and parents’ modeling of unhealthy relationships predict adolescent dating violence (ADV) victimization. Also tested was the possible moderating role of secure attachment on the relation between parental modeling of unhealthy relationships and ADV victimization. It was hypothesized that insecure attachment and parental modeling of unhealthy relationships would individually be associated with increased ADV victimization, and secure attachment would attenuate the predicted positive association between parental modeling of unhealthy relationships and ADV victimization. Participants were adolescents (N = 152, M age = 15.61 years, SD = 1.086, 74.3% girls), who completed a survey …


Vicarious Trauma And Doctoral-Level Trainees: Self-Care Practices, Elisabeth B. Gibson May 2022

Vicarious Trauma And Doctoral-Level Trainees: Self-Care Practices, Elisabeth B. Gibson

Doctor of Psychology (PsyD)

Research reflects correlations between trauma history and motivation to pursue a career in clinical psychology and mental health professions. Professional longevity is a concern for clinicians in general, especially for clinicians with a trauma history who work with people suffering with trauma conditions. Trauma histories measured by adverse childhood experiences (ACEs), are likely to be present within students of doctor of psychology training programs, and may influence doctoral trainee readiness and ability to engage clients in clinical work. Self-care is thought to not only support overall well-being, but to also mitigate the negative consequences of stress associated with clinical work. …


Resilience, Spirituality And Cultural Connectiveness Within The Native American/American Indian Indigenous Population, Lindsay Price May 2022

Resilience, Spirituality And Cultural Connectiveness Within The Native American/American Indian Indigenous Population, Lindsay Price

Doctor of Psychology (PsyD)

Native Americans, also known as the American Indian or Indigenous population, were colonized over four centuries ago by Europeans who brought many diseases which decimated this population. This immense trauma continued for generations as the settlers continued to violate Native American life and identity on every level. Hundreds of indigenous tribes endured massacre, annihilation of traditional culture, forced religious assimilation, stolen land, broken treaties, betrayal of rights, removal of identity, neglect, and constant abuse without any recompense. These violations still widely occur, yet the strength and flourishing of Native Americans remain ever-present. Their deep-rooted protective factors within resilience, like cultural …


The Happiest Place On Earth: A Grounded Theory Of Fulfillment In Mixed-Orientation Marriages, Isadora Ferreira De Melo May 2022

The Happiest Place On Earth: A Grounded Theory Of Fulfillment In Mixed-Orientation Marriages, Isadora Ferreira De Melo

Electronic Theses and Dissertations

Mixed-orientation marriages (MOMs) are often misunderstood. There is a general cynicism in research literature and in the broader culture regarding the relational viability of same-sex attracted (SSA) individuals who marry someone of the opposite sex. However, there exist couples in MOMs that are resilient and attain satisfaction. The purpose of this study is to better understand how MOMs might become successful. By interviewing maritally satisfied mixed-orientation couples, the Model of Relational Self- Determination in Mixed-Orientation Marriages was developed. This model is separated into five stages that are organized around the experience of disclosure of the SSA spouse’s sexuality. Depending on …


Barriers To The Use Of Palliative And Hospice Care Among The Latino Population, Diana Ramirez May 2022

Barriers To The Use Of Palliative And Hospice Care Among The Latino Population, Diana Ramirez

Electronic Theses, Projects, and Dissertations

Patients suffering from irreversible and terminal illnesses may benefit from the services provided by Palliative and Hospice Care to control any symptom burden and assist in navigating complex medical decisions. Many patients may express hesitation in accepting and enrolling to this service due to misconceptions. Language barriers may add an additional layer of complexity. This study explored the challenges Palliative Care providers encounter when introducing concept of hospice to Spanish-speaking patients their families for the first time. This study implemented qualitative research methods by using semi-structured one-on-one interviews. Ten members of an In-patient Palliative Care Team at a University Hospital …


Which Generation Is Having Safe Sex? Millennial Or Gen-Z, Rachel Silver May 2022

Which Generation Is Having Safe Sex? Millennial Or Gen-Z, Rachel Silver

Electronic Theses, Projects, and Dissertations

ABSTRACT

This research study aims to examine the sex practices of Millennials vs. Gen Z's. There are many concerns and questions about the long-term effects of hook-up culture for modern youth. In the last few years, there has been a rise in STDs and a decrease in teenage pregnancy. This quantitative research intends to find out where are education gaps are and the most significant motivators for young people to use protection and contraceptives through a list of questions in a survey. The goal is to understand better the similarities and differences between Millenials and Gen-Z's safe sex education and …


Inter-Agency Collaborations Among Mental Health And Law Enforcement Professionals In San Bernardino County During Covid-19: A Qualitative Study, Sonya Mcisaac May 2022

Inter-Agency Collaborations Among Mental Health And Law Enforcement Professionals In San Bernardino County During Covid-19: A Qualitative Study, Sonya Mcisaac

Electronic Theses, Projects, and Dissertations

As first responders, law enforcement officers and mental health professionals are constantly sought after regarding the delivery of critical services to people in need. However, the COVID-19 pandemic brought almost everything to a halt. It is therefore important to understand how social services were delivered during the crisis. It has been assumed in the literature that interprofessional collaboration is an important service delivery framework. However, because COVID-19 is a relatively recent public health phenomenon, relevant studies on interprofessional collaboration between law enforcement officers and mental health professionals are scant, if not non-existent. This qualitative study addresses this gap by exploring …


Dual Pathways To Burnout And Engagement: The Role Of Personal Goal Facilitation Through Work, Self-Discrepancy And Emotions, Bek Wuay Tang May 2022

Dual Pathways To Burnout And Engagement: The Role Of Personal Goal Facilitation Through Work, Self-Discrepancy And Emotions, Bek Wuay Tang

Dissertations and Theses Collection (Open Access)

According to the job-person fit framework, workplace burnout is often exacerbated by mismatches between the characteristics of the employee and the organization. Consistent with this view, past research has found that employees who perceive low personal goal facilitation through work (PGFW) report higher levels of burnout. However, personal goals were often assessed nomothetically, based on the assumption that individuals across occupational groups share similar personal goals they would like to achieve through work. The current research took an idiographic approach by examining if PGFW assessed based on individuals’ uniquely defined personal goals would predict burnout and work engagement. In addition, …


Addressing Work-Related Traumatic Stress Nebraska - Needs Assessment Summary, Quality Improvement Center For Workforce Development May 2022

Addressing Work-Related Traumatic Stress Nebraska - Needs Assessment Summary, Quality Improvement Center For Workforce Development

Other QIC-WD Products

Exploration of Needs

The Quality Improvement Center for Workforce Development (QIC-WD) worked with the Nebraska Department of Children and Family Services (DCFS) to conduct a needs assessment. The team leveraged: (1) administrative data, primarily from the Nebraska Department of Children and Family Services’ Human Resource department (DCFS-HR); (2) formal surveys of child welfare staff and supervisors; (3) QIC-WD team expertise; and (4) subjective perceptions and expertise from the Nebraska Workforce Project Team members.

DCFS-HR data included metrics and processes related to recruitment, hiring, and retention; culture and climate; and other workforce processes and initiatives, such as onboarding, mentoring, supervision, …


The Relationship Of Minority Stress With The Mental Health Of Lgbtq College Students On A Christian Campus With Non-Affirming Policies, Ethan Nicholas Smetana May 2022

The Relationship Of Minority Stress With The Mental Health Of Lgbtq College Students On A Christian Campus With Non-Affirming Policies, Ethan Nicholas Smetana

Electronic Theses and Dissertations

One foundational concept of the Minority Stress Model (Meyer, 2003) is that the stress is based on persisting social processes and structures. Consequently, research to further the available pool of empirical evidence on how institutions based in the dominant culture affect minorities is needed and valuable. This study seeks to examine the effects of dimensions of minority stress on the mental health outcomes of LGBTQ students at a Christian university with a non-affirming school policy. Further, this study is interested in how gratitude affects the impact that minority stress has on mental health as a potential protective factor. Participants were …


Present Limitations And Future Projections: Food Insecurity, Housing Insecurity And Optimism Among College Students, Amber Obermaier May 2022

Present Limitations And Future Projections: Food Insecurity, Housing Insecurity And Optimism Among College Students, Amber Obermaier

Graduate Theses and Dissertations

Within the last decade, research has identified wide-ranging disparities in access to basic needs among university students. These differences, such as a lack of adequate food and housing during university, provide a negative environmental experience with potential to limit one’s optimism or hope for the future. This research explores how basic needs insecurity and social vulnerabilities among college students are related to subjective assessments of their prospects for the future. The present study utilizes survey data from a random sample of college students (n=300) enrolled at an urban university in the Midwest region of the United States of America. Logistic …


Witnessing Parental Violence And Cyber Ipv Perpetration In Hispanic Emerging Adults: The Mediating Role Of Attitudes Toward Ipv, Ines Cano-Gonzalez, Ruby Charak, Ohad Gilbar, Rosa Viñas-Racionero, Megan K. Strait May 2022

Witnessing Parental Violence And Cyber Ipv Perpetration In Hispanic Emerging Adults: The Mediating Role Of Attitudes Toward Ipv, Ines Cano-Gonzalez, Ruby Charak, Ohad Gilbar, Rosa Viñas-Racionero, Megan K. Strait

Psychological Science Faculty Publications

Recent studies indicate that the perpetration of intimate partner violence via cyberspaces (cyber IPV), namely, psychological aggression, sexual aggression, and cyberstalking is high among emerging adults. However, little is known of the risk factors that lead to cyber IPV and far lesser within Hispanic adults. Based on the intergenerational transmission of violence hypothesis, the present study examined the indirect effect of witnessing parental violence during childhood on the three types of cyber IPV through attitudes condoning IPV in Hispanic men and women, separately. Participants were 1,136 Hispanic emerging adults in the age range of 18-29 years (M = 20.53 …


Coordination In Healthcare Multiteam Systems: A Qualitative Study Of Healthcare Meetings, Anna Wolf May 2022

Coordination In Healthcare Multiteam Systems: A Qualitative Study Of Healthcare Meetings, Anna Wolf

All Theses

To facilitate optimal patient care and outcomes for in-patent cancer patients, healthcare organizations often rely upon the coordinated efforts between specialized teams of healthcare providers, working interdependently in a structure known as a Multiteam System (MTS). Healthcare meetings, such as Rounds, particularly those with an interdisciplinary element, may act as care coordination mechanisms for in-patient MTS. This research investigates an MTS operating within the Southeastern United States whose teams use Rounds and other meetings called SNAP Huddles, to facilitate patient care. Through qualitative analysis using interviews and observations, this exploratory study aims to elucidate research questions relating to how Rounds …


Implementing An Online, Integrative, Multi-Component, Group-Based Cognitive Behavior Therapy (Cbt) For The Reduction Of Caregiver Burden In Primary Familial Caregivers Of Persons With Dementia: A Preliminary Test Of Feasibility, Daniel Robert Schaffer May 2022

Implementing An Online, Integrative, Multi-Component, Group-Based Cognitive Behavior Therapy (Cbt) For The Reduction Of Caregiver Burden In Primary Familial Caregivers Of Persons With Dementia: A Preliminary Test Of Feasibility, Daniel Robert Schaffer

Psychology Theses & Dissertations

The purpose of this study was to examine the preliminary feasibility of an online, manualized, group-based, multi-component, cognitive behavioral therapy (CBT) treatment approach for the reduction of caregiver burden among family caregivers of persons with dementia. This study had five primary hypotheses: (1) the recruitment plan, as outlined within this study, would yield the target number of participants within a 12-month period; (2) the proposed group therapy protocol would produce a positive therapeutic climate, as operationalized by increased levels of perceived social support, perceived group cohesion, positive therapeutic alliance, and positive engagement; (3) this study would maintain adequate participant retention, …