PONE-D-23-22258Online therapy with families - what can families tell us about how to do this well? A qualitative study assessing families' experience of remote Dyadic Developmental Psychotherapy compared to face-to-face therapyPLOS ONE

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Please revise your manuscript according to the reviewers' comments. Especially, please consider to apply the COREQ criteria mentioned by one of our reviewers.

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Reviewers' comments:

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Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is an interesting qualitative study exploring the experience of adoptive parents (I'll comment later on the title of the article) receiving Dyadic Developmental Therapy (DDP); this study is part of a broader clinical trial that aims to assess the clinical and cost effectiveness of DDP compared to services as usual. The link between this qualitative study and the quantitative evaluation is clear and well justified.

Here are a number of remarks and comments which I hope will improve the rigor of this manuscript

INTRODUCTION

p.4 : more details are needed regarding the ethical concerns emerging regarding the negative impact of “tele-mental-health” (p. 4, li 75-76)

The paragraph on the qualitative studies carried out among therapists on their experience of online therapy is really interesting

There is a lack of transition between the first major part of the introduction on the evaluation of online therapies, and the second part on the Dyadic Developmental Psychotherapy.

Typo p. 5, li 103: “Rooted in attachment theory; the primary goal of DDP” the semicolon must be replaced by a comma”.

The goals and major therapeutic targets of the DDP are well described on the child's side, but we don't really understand what is being worked on with the adoptive parents. Viewing Table 1, I understand that the DDP includes sessions for the child and sessions for the parents? This must be clarified.

METHODS:

I strongly recommend that authors follow the COREQ criteria (Tong et al. 2007); most of the information required by this checklist is already mentioned in the manuscript, but some is missing. This guide would provide greater precision and clarity.

Are DDP sessions protocolised? More precisely, is there an average number of sessions? This question is linked to an inclusion criterion: “families (…) who had received at least one session of DDP”. Justification for this inclusion criterion? And I’m not sure the parents can fully answer to a question concerning their experience of therapy with only one session.

Some aspects of the procedure are unclear: if I understand correctly, the 6 families contacted agreed to participate to the study? How were the participants in the RIGHT trial selected? In the same way, how were the participants of Adoptionplus selected?

Do the authors, as therapists, know the participants before the study? Were they involved, and in what capacity, in patients’care?

The choice of IPA is insufficiently justified; it is a very specific method which does not only allow access to the lived experience of individuals (a thematic analyze also allows this). Attention to the meaning-making processes is central, and the specific contribution of this method is not well understood here. I'll continue my comments on IPA in the results section.

RESULTS

See the new terminology that Smith and his colleagues have adopted: http://www.ipa.bbk.ac.uk/news/events

Some subthemes appear to be quite redundant. For instance, the subtheme “a very clear boundary” (p. 13) is very close to the superordinate theme of “travel”, especially with the subtheme “the driving back was decompression” (these two elements are by the way discussed together in the discussion section).

The part about car/public transportation journeys after the session and everything that goes on in them is really very interesting. This could be given greater prominence, particularly in the discussion section.

Unfortunately, this study can be criticized for its lack of conceptual and methodological precision, which is precisely what is being criticized in the Smith’s methods. More precisely: what exactly is a theme (superordinate or subtheme)? What is really phenomenological in the results? Where is the interpretative account? See Van Manen, M. (2017). But is it phenomenology? (Editorial). Qualitative Health Research, 27, 775–779. See also Van Manen, M. (2018). Rebuttal rejoinder: Present IPA for what it is—Interpretative psychological analysis. Qualitative health research, 28(12), 1959-1968.

I think that if the authors were to clarify a number of points concerning the recruitment procedure, other limitations would become apparent (selection bias, for example). All studies have biases, of course, it's just a question of being more precise and transparent.

Reading the results, it's clear that this is not about the family experience of DDP, but about parents’ experience.

DISCUSSION

The results are well discussed in the light of previous studies, but the discussion section does not provide any additional elements concerning the meaning-making processes regarding the therapy experience, which should nevertheless be at the heart of an IPA. I therefore suggest that the authors inject more elements regarding the processes at work in the therapeutic relationship, which they cite without detailing; for example, emotional regulation and the fact that this is a process that needs time to be worked on (link with the theme of the journey; see for instance Gross, J. J. (2001). Emotion regulation in adulthood: Timing is everything. Current directions in psychological science, 10(6), 214-219. Or: Cole, P. M., & Hollenstein, T. (Eds.). (2018). Emotion regulation: A matter of time. Routledge.). Similarly, the identification of therapist skills could be linked to empathy and the importance of intersubjectivity in child development (see Fonagy’s work).

In short, the discussion really needs to be given a more phenomenological consistency; otherwise the study, which is really of good quality, is "only" a thematic analysis (which is quite valid, but does not correspond to what is advertised).

I hope these remarks will help the authors in the very important field of evaluating the quality of our interventions!

Reviewer #2: Blair et al. reported on an interesting topic on dyadic developmental psychotherapy. The manuscript is well-structured and comprehensive, and the conclusion is solid. However, there are still some minor issues that should be addressed before acceptance.

1.The abstract is too long. It is suggested to cut the abstract and concentrate it to be more logical.

2.The language should be carefully polished. There are some inappropriate sentences and words, which should be carefully revised.

3.Please double-check the format of the references.

4.The discussion part should be more in-depth. The current version is too short.

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Reviewer #1: Yes: Léonor FASSE

Reviewer #2: No

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Online therapy with families - what can families tell us about how to do this well? A qualitative study assessing families' experience of remote Dyadic Developmental Psychotherapy compared to face-to-face therapy

PONE-D-23-22258R1

Dear Dr. Monica Blair,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Zhengwei Huang

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

After checking the revised manuscript and the new comments from the second round of review, I supposed that the current version had been well improved, and could be considered for publication in PLoS One.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: (No Response)

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If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

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