Factors promoting alliance quality: Differentiation of therapeutic alliance according to the formal aspects of the psychotherapeutic process and demographic variables

Background and Objectives The study's main aim was to determine which formal aspects of psychotherapy (therapist's work experience, number of sessions held, frequency of meetings, length of sessions) contributed to the quality of the therapeutic (working) alliance. The alliance was also analyzed for demographic variables. Methods The sample consisted of 428 participants, and the working alliance was evaluated in 262 psychotherapist–patient dyads. To assess its quality, the author used the full version of the Working Alliance Inventory (WAI). Results The analyzes led to several conclusions. Their results indicate that the quality of working alliance increases if psychotherapy is conducted by an experienced specialist, if the frequency of sessions is high, and if the sessions are longer. They do not, however, pinpoint the demographic markers of therapeutic alliance quality. Conclusion The formal aspects of the psychotherapeutic process influence the quality of the working alliance. Alliance develops to an equal degree in people of different ages and with diverse levels of education, regardless of the presence or absence of close interpersonal relationships in their lives. (AU)

Trastorno por consumo de sustancias en adolescentes: reporte de un caso / Substance use disorders in adolescents: A case report

Introduction: Adolescence is a critical period of development during which young people are vulnerable to engaging in risky be haviors, including drug use. Early use of psychoactive substances can interfere with normal development and have both short-term and long-term social and health problems. Objectives: This case report aims to review important aspects of the substance abuse disorder treatment in teenage patients, based on the detailed description of a clinical case. Methods: Description of a clinical case of an 18-year-old patient who began using psychoactive substances at the age of 13. The information used in the review was gathered from relevant publications found through a selective search in PubMed on substance use disorders in children and adolescents. Results: This case report describes the substance use disorder of an 18-year-old female patient, who began using psychoactive substances at the age of 13. The patient had a history off loss of her mother, depressive symptoms and self-injurious behavior, which likely contributed to her increased risk for substance use. The patient’s substance use began with tobacco and gradually progressed to cannabinoids, ecstasy, opioids, and cocaine. Due to her continued substance use, she was referred for consultation at a specialized treatment team. The patient received a combination of psychotherapeutic interventions for substance use and individual therapy. The plan included also coordination with social work and psychology, and the involvement of the individual’s family in the process.Despite these efforts, the patient was ultimately hospitalized for severe self-harm behaviors and entered a therapeutic community.Discussion and Conclusion: This case highlights the complexity of substance use disorders in adolescents and the importance of addressing multiple individual and environmental factors in order...(AU)

Introducción: La adolescencia es un período crítico del desarrollo durante el cual los jóvenes son vulnerables a adoptar conductas de riesgo, incluyendo el consumo de drogas. El uso temprano de sustancias psicoactivas puede interferir con el desarrollo normal y tener problemas sociales y de salud, tanto a corto como a largo plazo.Metas: Este reporte de caso tiene como objetivo revisar aspectos fundamentales del tratamiento del trastorno por abuso de sustancias en pacientes adolescentes, a partir de la descripción detallada de un caso clínico.Métodos: Descripción de un caso clínico de una paciente de 18 años que empezó a consumir sustancias psicoactivas a partir de los 13 años. La información utilizada en esta revisión se obtuvo de publicaciones relevantes encontradas mediante una búsqueda selectiva, en la plataforma PubMed, sobre trastornos por consumo de sustancias en niños y adolescentes.Resultados: Este reporte de caso describe el trastorno por consumo de sustancias de una paciente de sexo femenino de 18 años, que empezó a consumir sustancias psicoactivas a partir de los 13 años. La paciente tenía antecedentes de pérdida de su madre, síntomas depresivos y comportamiento autoagresivo, que probablemente contribuyó a su mayor riesgo de consumo de sustancias. El consumo de sustancias de la paciente empezó con el tabaco y progresó gradualmente a cannabinoides, éxtasis, opioides y cocaína.Debido al consumo continuado de sustancias, fue derivada a consulta, a un equipo de tratamiento especializado. La paciente recibió una combinación de intervenciones psicoterapéuticas para el uso de sustancias y terapia individual. El plan incluía también la coordinación con trabajo social y psicología, y la participación de la familia en el proceso. A pesar de estos esfuerzos, la paciente finalmente fue hospitalizada por conductas autolesivas severas y ingresó a una comunidad terapéutica.(AU)

Beliefs About Psychological Problems Inventory (BAPPI): Development and Psychometric Properties

The clients’ belief systems are components of Effective Therapy Relationships. Thus, it is desirable to include clients’ beliefs about their psychological problems on systematic assessment protocols underlying the process of systematic treatment selection and of tailoring the treatment to the person. However, assessment instruments which specifically capture clients’ beliefs about their psychological problems are scarce. The objective of the studies presented was to evaluate the psychometric properties of the Beliefs About Psychological Problems Inventory (BAPPI), an assessment instrument of the clients’ beliefs about their psychological problems. Study 1 (Exploratory Factor Analysis) involved 200 participants, and Study 2 (Confirmatory Factor Analysis and other validity studies), involved 545 participants. Results revealed that the BAPPI presents a stable factorial structure of six dimensions (Psychodynamic, Humanistic, Biomedical, Cognitive-Behavioral, Systemic, and Eclectic/Integrative). Altogether, analyses of items, internal consistency, reliability, and external validity revealed that the BAPPI is a valid assessment instrument for use in mental health research and practice, especially in the process of systematic treatment selection and, therefore, of matching/tailoring the treatment to the client’s characteristics (AU)

Evaluación de resultados naturalística en psicoterapia / Naturalistic outcomes assessment in psychotherapy

Introducción y objetivos: La evaluación naturalística de resultados en psicoterapia es una necesidad del clínico para valorar la efectividad de su trabajo y, de esta manera, corregir las posibles deficiencias en su desempeño. El presente estudio valoró los resultados de una intervención psicoterapéutica realizada desde la terapia centrada en soluciones de un psicólogo clínico en su práctica privada durante cinco años. Además, se evaluó la relación de los resultados con diferentes variables sociodemográficas, clínicas y de modelo, en busca de un perfil que se beneficiase especialmente del proceso psicoterapéutico. Material y métodos: La muestra estuvo formada por 249 personas entre 11 y 78 años. Se realizó una evaluación naturalística implementando un protocolo de evaluación de resultados en el trabajo clínico cotidiano. Se administró la Escala de Evaluación de la Actividad Global (EEAG) para valorar la gravedad de la sintomatología y el menoscabo de los casos. También se evaluaron variables sociodemográficas, clínicas y de modelo. Resultados: El 75.5% de la muestra tuvo un resultado de éxito en terapia. Este porcentaje subió hasta el 85.8% si solo se tenían en cuenta las personas que se consideraban que habían finalizado el tratamiento psicoterapéutico. La edad, la etapa vital, la gravedad sintomatológica y el haber estado anteriormente en tratamiento terapéutico se relacionaron, aunque de forma débil, con los resultados. Conclusiones: Estos resultados apoyan la hipótesis de la efectividad de la psicoterapia y la solidez de la misma en diferentes perfiles sociodemográficos y clínicos.(AU)

Introduction and objectives: The naturalistic outcomes assessment in psychotherapy is a requirement for the clinician to evaluate the effectiveness of his work and, in this way, correct possible deficiencies in his performance. The present study evaluated the outcomes of a psychotherapeutic intervention carried out from the solution-focused therapy of a clinical psychologist in his private practice for five years. In addition, the relationship of the outcomes with different sociodemographic, clinical and model variables was evaluated, in search of a profile that would benefit especially from the psychotherapeutic process. Material and methods: The sample was comprised of 249 people aged 11 and 78 years. A naturalistic evaluation was carried out implementing a protocol for assesing outcomes in the routine clinical work. The severity of the symptoms and the impairment of the cases were measured by the Global Assessment Functioning Scale (GAF). Sociodemographic, clinical and model variables were also evaluated. Results: 75.5% of the sample had a successful outcome in therapy. This percentage rose to 85.8% if only people who were considered to have completed psychotherapeutic treatment were taken into account. Age, life stage, symptomatic severity, and having previously been in therapeutic treatment were related, although weakly, to the results. Conclusions: These outcomes support the hypothesis of the effectiveness of psychotherapy and its strength in different sociodemographic and clinical profiles.(AU)

A systematic review of values interventions in acceptance and commitment therapy

Acceptance and Commitment Therapy (ACT) is characterized by a focus on contextual change and advances topics like acceptance, mindfulness, values, spirituality and relationship. It sets itself apart from other third wave approaches by bringing to the center of the therapeutic work values clarification and living. Previous systematic reviews provided support for the efficacy and effectiveness of Acceptance and Commitment Therapy (ACT) but it's unknown of reviews that comprehensively assess values interventions with a focus on examining the specific effects of working with values or meaning in life in a wide variety of settings, populations and methodological designs. The goal of this study is to investigate empirical interventions that utilizes values as conceptualized by ACT. Systematic searches in 5 databases were performed up to April 2020. For inclusion, the intervention study must have targeted values process as conceptualized by ACT. Systematic reviews, theoretical or conceptual papers were excluded. Analyzed data were publication year, language, country, number and description of participants, mean age, sample origin, outcome variables, study design and quality and overall results. Seventeen studies were identified. Results show a broad scope of research methods, in a variety of settings and populations. According to reported results, values interventions had the desired effect on the outcome variable

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Modelo conductual-contextual de las relaciones íntimas: aplicabilidad en psicoterapia / Behavioral-contextual model of intimate relationships: applicability in psychotherapy

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Intimate relationships matter for both human's physical and psychological health. Although many theories have been developed to study this topic, there is no consensus about the underlying processes in human relationships. The Interpersonal Process Model, which has well-established empirical support, aims to address the development of intimate relationships describing them as observed behaviors. This has important implications in psychotherapy, especially for those approaches that understand the interpersonal patient-therapist relationship as a tool for change. That is the case of Functional Analytic Psychotherapy. In this paper we articulate a model of intimate relationships based on Interpersonal Process Model and the principles of Functional Behavioral Analysis, connecting it with previous results on the field of intimate relationships. Likewise, a discussion about its implications in psychotherapy and its utility to solve some Functional Analytic Psychotherapy's limitations is presented

Mirando atrás para seguir avanzando. Una reflexión crítica sobre el pasado y el presente de la atención en salud mental (II) / Looking back to keep moving forwar (d. A critical reflection on the past and present of mental health care (II)

Este es el segundo de una serie de dos artículos que tratan de hacer una valoración crítica de los principales aspectos teóricos y técnicos relacionados con la atención en salud mental que se han desarrollado en las 6 o 7 últimas décadas, como alternativa a dos tipos de posiciones consideradas inadecuadas, la del reduccionismo biomédico imperante y la de algunas tendencias nuevamente “antipsiquiátricas”. En este segundo artículo se valoran algunos movimientos interesantes de estos últimos años y se plantean algunas conclusiones y perspectivas de futuro, tratando de situarse en una perspectiva crítica razonable desde el marco de la atención comunitaria en salud mental. Considerada esta como el paradigma tecnológico desde el que cabe dar cuenta de la complejidad de los problemas de salud mental y ayudar a resolverlos en una interacción no menos compleja entre profesionales y usuarios y usuarias

This is the second of two papers that seek to make a critical assessment of the main theoretical and technical aspects related to mental health care developed in the last six or seven decades, as an alternative to two types of positions considered inadequate; namely, that of the dominant biomedical reductionism and those of some new "antipsy-chiatric" tendencies. In this second paper some interesting movements from recent years are valued and some conclusions and prospects for the future are raised, trying to take a reasonable critical stance from the community mental health care framework. This latter one considered as the technological paradigm from which it is possible to take into account the complexity of mental health problems and to solve them in a no less complex interaction between professionals and users

Jacques Lacan y la práctica pública en salud mental / Jacques Lacan and public practice in mental health

Se revisa la relación entre las teorías de Freud y Lacan, a propósito de recientes investigaciones que encuentran notables diferencias entre ellas. A través de la reflexión sobre diversos aspectos del trabajo público en salud mental, y varios ejemplos clínicos, se propone que la enseñanza de Lacan permite un psicoanálisis más acorde a la práctica actual, que en buena parte se ejerce sin las condiciones para las que Freud diseñó su método

This paper reviews the relationship between Freud’s and Lacan’s epistemologies, in light of recent research that considers these two major psychoanalytic schools of thought as significantly different. By reflecting on his experience in the public mental health sector, including clinical vignettes, the author proposes that Lacan’s teaching allows for a psychoanalytic work better adjusted to the contemporary clinical practice, which typically takes place in conditions that are far from those required by a classic Freudian approach

Elaboración y validación de un cuestionario para detección del riesgo de reacciones adversas graves por empleo de drogas psicodélicas en terapia / Development and validation of a questionnaire to detect the risk of serious adverse reactions due to the use of psychedelic drug in therapy

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The use of psychedelic drugs for the treatment of some mental disorders is increasing. However, their use is associated to certain risks, being the most important the exacerbation of mental disorders, mainly psychosis or bipolar disorder. While both 3,4-methylenedioxymethamphetamine (MDMA) and psilocybin are on the Phase-III of the process of drug commercialization, there are not enough screening strategies in order to ensure the safety of patients who will receive those treatments. This article presents the development and validation of a test that assesses the risk of developing psychotic or bipolar disorders using two samples of 156 and 510 participants. The Graded Response Model from Item Response Theory was used. The final version of the test, composed by 30 items, shows very satisfactory psychometric indices, allowing its use as a screening tool in experimental or clinical settings

Influence of experience on the thought process of clinical psychologists: an analysis from the dual-process theories framework

In the course of their work, psychologists must make judgments and complex decisions, skills that are part of clinical reasoning. Recent models approach the analysis of such process using the dual-process theories framework. This study provides an assessment of the two systems, System 1 and System 2, in forty-five clinical psychologists with different levels of experience (novices, intermediates and experts) with the purpose of exploring their level of activation and evolution throughout such stages of expertise. According to the results, clinical psychologists mainly activate System 2, M = 70.91, SD = 6.71, than System 1, M = 60.49, SD = 3.78; when performing their clinical duties. However, no significant changes have been observed regarding the preferential use of thinking Systems 1 or 2 throughout the experience, both systems are used in a similar way in the different levels of expertise analyzed, with an increase of System 2 at the intermediate level of expertise. The results are analyzed in terms of intermediate effect and discussed focusing on the unremitting need for System 2 in psychologist work given the idiosyncratic characteristics of each case requiring treatment in the area of psychology and on the relationship of the two systems in clinical reasoning

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Are positive interventions always beneficial?

Can people improve their lives by smiling more, trying to have a better posture, and by thinking about good memories? Can individuals become more successful by deliberatively engaging in positive actions and thoughts? Do people feel better by following recommendations from naïve psychology? In the present article we discuss these questions, noting that although some popular interventions thought to be universally beneficial (e.g., inductions of happiness, self-affirmation, empowerment, self-distancing) can sometimes yield positive outcomes, at other times the outcomes can also be negative. Taking an empirical approach based on experimental evidence, we postulate that understanding the underlying processes discovered in the science of persuasion is the key for specifying why, when, and for whom these practical initiatives are more likely to work or to backfire

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Pericia, efectos del terapeuta y práctica deliberada: El ciclo de la excelencia / Expertise, therapist effects and deliberate practice: The cycle of excellence

La Práctica (Clínica) Basada en la Evidencia se define como la integración de la mejor investigación disponible con la pericia clínica y las características, preferencias y cultura del paciente. Del mismo modo, la variable terapeuta empieza a mostrar su influencia decisi-va en el resultado de los tratamientos psicológicos. En este trabajo se pone el énfasis en la figura del terapeuta en el contexto del pro-grama de formación PIR de especialistas en Psicología Clínica de nuestro Sistema Nacional de Salud. Se revisan los constructos pericia, efectos del terapeuta y se presenta la Práctica Deliberada como un sistema de entrenamiento que puede ayudar a mejorar los resultados de los clínicos y sus tratamientos. Se realizan recomendaciones concretas para mejorar el modelo de supervisión durante la residencia PIR y se discuten algunas de las implicaciones y limitaciones del estado actual de la cuestión

Evidence-based (clinical) practice is the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences. Similarly, the therapist factor is beginning to show its decisive influence on the outcome of psychological treatments. This paper emphasizes the therapist factor in the context of the PIR training program of Clinical Psychology specialists within our National Health System. Expertise and therapist effects are reviewed and deliberate practice is presented as a training system that can help clinical psychologists to improve their outcomes and treatments. Specific recommendations are made to improve the supervision model during PIR training and the implications and limitations of the topic are discussed

Effective psychotherapeutic approaches to treatment for ethnic minorities

Members of the Sikh Khalsa who make their residence in the United States represent a psychologically underserved and understudied population. A lack of awareness of psychological services contributes to this status; however, the challenges inherent in reconciling cultural norms within the United States with the native cultures of immigrant populations should not be neglected. As a consequence of the paucity of ethnically Sikh psychotherapists, the number of therapists with a competent cultural understanding of this population is limited. By sharing the insights and observations culled from dialogue with members of a Sikh community recovering in the wake of a national tragedy, we present our insights and an approach to therapeutic intervention developed to facilitate future psychotherapeutic endeavors both in Sikh communities and other ethnic minorities at large. The model developed in this study identifies demographic issues, therapeutic approach, gender bias, language, confidentiality, peer support, and immigrant status as the most important factors when treating this population. Ultimately, it is our intention to elevate awareness of some of the idiosyncratic complexities involved in treatment and research of this underserved minority group, particularly as our population continues to diversify

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Miedo a la verdad: confusiones del analista «traumatizado» / Fear of truth: confusions of the "traumatized" analyst / Peur de la vérité: confusions de l'analyste «traumatisé»

Fundamentalmente el psicoanálisis trata de la verdad; su tarea es analizar la relación analítica de manera profunda y verdadera y nada lo muestra mejor que el intento de enseñarlo. El trabajo con candidatos y analistas ha fortalecido mi convicción de que, para trabajar eficazmente como analista, se necesita una profunda confianza personal en el proceso psicoanalítico basada en la experiencia íntima de que la confrontación con el inconsciente en los propios análisis ha sido algo decisivo y positivo. Este hecho fomenta la confianza en el impacto saludable de lo que yo llamo la veracidad del psicoanálisis. Sin embargo, esta sincera búsqueda de la verdad en ocasiones está bloqueada por miedos inconscientes por parte del analista. Se produce entonces fácilmente una transmisión de inseguridad y de desmentida, como resultado de un trauma mutuamente desmentido. Sándor Ferenczi ha sido el primero en llamar la atención sobre esta posible colusión peligrosa en su ensayo sobre «La confusión de lenguas entre los adultos y el niño» en 1932. Esta situación puede promover fácilmente falsos desarrollos en los procesos de formación, con el consecuente peligro de inhibir permanentemente el potencial del candidato

Fundamentally, psychoanalysis deals with truth. It is tasked with exploring the analytic relationship in a deep and truthful way and nothing demonstrates this better than the attempt to teach it. Work with candidates and analysts has strengthened my conviction that to work effectively as an analyst requires a profound personal trust in the psychoanalytic process based on one's own intimate experience that the confrontation with the unconscious in analysis has been decisively significant and positive. This fact fosters trust in the healthy impact of what I call the 'veracity' of psychoanalysis. However, this sincere quest for truth is at times blocked by unconscious fears on the part of the analyst. Uncertainty and disavowal can then easily be transmitted as a result of a mutually-denied trauma. Sándor Ferenczi was the first to draw attention to this hazardous potential collusion in his essay "Confusion of. the t?~gues" (1932). T~is situation can easily foster false developments m trammg processes, with the consequent risk of permanently inhibiting the candidate's potential

La psychanalyse traite fondamentalement de la vérité; sa tâche est d' analyser la relation analytique de maniere profonde et véntable et nen ne le montre mieux que la tentative de le transmettre. Le travail avec des candidats et des analystes a renforcé ma conviction suivant laquelle, pour travailler efficacement comme analyste, on a besoin d'une profonde confiance personnelle dans le processus psychanalytique basée sur l'expérience intime que la confrontation avec l'inconscient dans les analyses personnelles a été quelque chose d'important et de positif. Ce fait renforce la confiance dans l'impact sain de ce que j'appelle la véracité de la psychanalyse. Toutefois, cette sincere recherche de la vérité est bloquée a certaines occasions par des peurs inconscientes de la part de l' analyste. Il se produit alors facilement une transmission d'insécurité et de déni, comme résultat d'un traumatisme mutuellement dénié. Sándor Ferenezi a été le premier a attirer l' attention sur cette possible collusion dangereuse dans son essai sur «La confusion des langues» en 1932. Cette situation peut promouvoir facilement de faux développements dans les processus de formation, avec le danger conséquent d'inhiber de façon permanente le potentiel du candidat

A propósito de un caso de construcción psíquica de la subjetividad / On a case of psychic self-construction / Á propos d'un cas de construction psychique de la subjectivité

A partir de un caso clínico, desarrollo el presente trabajo en y desde el vínculo transf ero-contratransf erencial, con un material que permite reflexionar sobre aquello que, desde el discurso del sujeto, nos induce a pensar- sentir-actuar: contenidos no simbolizados, vehiculizados por palabras portadoras de significados no atravesados por la falta, que ponen a prueba nuestra disponibilidad psíquica para acompañar en un proceso de paulatinas transformaciones de la omnipotencia infantil. Funcionamiento que anega al paciente en intensos sentimientos de terror y le aprisiona en un mundo cerrado e incestuoso, con graves consecuencias para su desarrollo. Solo aspirando a ser protagonista activo de la historia pasada y presente, el sujeto puede abrirse a la perspectiva de futuro, como consecuencia de la renuncia a anhelos inalcanzables

Drawing from a clinical case, this article is elaborated in and from the transference/ countertransference link. The case material provides an insight into that which, from the standpoint of the discourse of the subj ect, induces us to think-feel-act. These unsymbolised contents, conveyed through words bearing meaning not permeated by lack, test our psychic availability to accompany the patient in a process of gradual transformations of infantile omnipotence, a functioning that floods the patient with intense feelings of terror and imprisons her in a closed-off and incestuous world, with severe developmental consequences. Only by aspiring to be an active protagonist of history - past and present - is the subject able to make way for the future perspective, as a consequence of the renunciation of unattainable wishes

A partir d'un cas clinique, je développe le travail présent dans et a partir du lien transféro-contratransferentiel, avec un matériel qui permet réfléchir sur ce qui, partant du discours du sujet, nous induit a penser-sentir-agir: contenus non symbolisés, véhiculasses par des mots porteurs de sens non traversés par le manque, qui mettent a l' épreuve notre disponibilité psychique pour accompagner dans un processus les transformations progressives de la toute-puissance infantile. Fonctionnement que plonge le patient dans d'intenses sentiments de terreur et l'emprisonne dans un monde fermé et incestueux, avec de séveres conséquences pour son développement. Seulement en aspirant a étre protagoniste actif de l'histoire passée et présente, le sujet pourra s'ouvrir a la perspective de futur, comme conséquence du renoncement a des aspirations inatteignables

Factores terapéuticos en psicoterapia grupal: un estudio desde la perspectiva de los participantes / Therapeutic factors in group psychotherapy: a study from the perspective of group members

En el presente trabajo, los autores Investigan qué factores terapéuticos grupales (FTG) son los de mayor importancia para los participantes de psicoterapia de grupo. Una adaptación del cuestionario Yalom fue completada por 88 usuarios de un servicio ambulatorio de salud mental, analizándose las diferencias según características sociodemográficas, diagnóstico y la valoración de los conductores grupales. A nivel jerárquico, la universalidad, el altruismo y la cohesión fueron los FTG más valorados; por el contrario, la conducta imitativa y los factores existenciales fueron los que menos. Aquellos usuarios con un mayor nivel de estudios valoraron significativamente la reactualización familiar, sin observarse diferencias en la edad ni el sexo. El diagnóstico de un trastorno del espectro de la esquizofrenia presentó una elevada correlación con la cohesión, la catarsis y la universalidad. Las valoraciones de los terapeutas concuerdan de forma significativa con las de la muestra. La evaluación de los FTG permite que los terapeutas contemplen aquellos elementos que más favorecen a los usuarios en su proceso psicoterapéutico y en su mejora del bienestar

In the present work, the authors investigate which group therapeutic factors (GTF) are the most important for group psychotherapy participants. 88 users of an outpatient mental health service completed an adaptation of the Yalom's questionnaire. Differences regarding sociodemographic characteristics, diagnosis and assessment of the group therapists were analyzed. At the hierarchical level, universality, altruism and cohesion were the most valued GTF; while identification and existential factors were the least ones. Those users with a higher level of studies valued the family reenactment significantly, without observing differences regarding age or sex. The diagnosis of a schizophrenia spectrum disorder showed a high correlation with cohesion, catharsis, and universality. The therapists' scores correlated significantly with the sample scores. The evaluation of the GTF allows therapists to contemplate those elements that are most helpful for the users in their psychotherapeutic process and in the improvement of their well-being

The evolving definition of cultural competency: a mixed methods study

This research established a definition of cultural competency from the perspective of the psychologists using mixed methodology. In Study 1 (N= 9) participants were interviewed and asked how they conceptualize cultural competency; three emergent themes were identified: awareness, knowledge, and skills. Based on the results from Study 1, a survey was created for Study 2 and completed by psychologists (N= 142). Results from a confirmatory factor analysis did not support cultural competency as a 3-dimensional construct. A post-hoc exploratory factor analysis suggested that cultural competency is best conceptualized as a 2-dimensional construct consisting of knowledge/awareness and skills. Results suggest that the knowledge needed to work with diverse populations is more than simply knowing about the major cultural groups in the United States; a more sophisticated level of knowledge is needed as there are many cultures and sub-cultures

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En busca de la dimension clínica del apego a través de las narrativas infantiles / In search of the clinical dimension of attachment through children's narratives

La dimensión clínica de la Teoría del Apego permanece insuficientemente desarrollada, pero pueden encontrarse interesantes propuestas actuales en este ámbito. Abordamos los principios básicos que deben sostener un acercamiento clínico a la Teoría del Apego: situar el apego en el conjunto de sistemas motivacionales, atender a los distintos niveles de seguridad que comprende (físico, emocional, cognitivo) y considerar los procesos de autoregulación dañados por fallos en las relaciones de apego. Abordamos el papel de las narrativas en el desarrollo infantil, y su uso para evaluar las construcciones internas del apego; finalmente exponemos con detalle el uso de la Attachment Story Completion Test (ASCT) como instrumento útil para su evaluación

Clinical dimension of Attachment Theory is still illdeveloped, but interesting current proposals can be found. Basic principles necessary to bear a clinical approach to Attachment Theory are explained: placing attachment among other motivational systems, paying attention to the different safety levels included in attachment (physical, emotional, cognitive) and taking into account self-regulation processes which could be hampered by failures in attachment. The role of narratives in child development, and its utility to assess attachment internal models are considered; finally, a detailed account of the use of Attachment Story Completion Test (ASCT), as an useful assessment tool, is presented

Intimidad y tolerancia a la soledad en la adolescencia / Intimacy and tolerance for loneliness in adolescence

Se plantean reflexiones acerca del sentimiento de intimidad y su correlato, la tolerancia a la experiencia de soledad, en los y las adolescentes de hoy, que viven bajo uno de los ideales centrales de las sociedades contemporáneas, al menos en el mundo desarrollado, que es el de la exteriorización, tanto de aspectos corporales como del mundo psíquico interno. Desde el nacimiento, apoyándose en lo biológico, en las necesidades y la experiencia de dependencia, el ser humano organiza su psiquismo estableciendo límites entre su mundo interno y la realidad externa. Entre las primeras adquisiciones del bebé, la capacidad de estar solo, será precursora del espacio de intimidad que le acompañara a lo largo de la vida, y será un elemento inevitable y necesario para apoyar las trasformaciones identitarias, tanto corporales como psíquicas, del proceso adolescente. Se abordan, asimismo, aspectos relativos a la experimentación de la intimidad en situaciones de soledad y al pasar a ser compartida, incluyéndose las relaciones terapéuticas con su especificidad durante el periodo de la adolescencia

Reflections are made about the feeling of intimacy and its correlate, the tolerance to the experience of loneliness, in the adolescents of today, who live under one of the central ideals of contemporary societies, at least in the developed world, which is the one of the exteriorization, as much of corporal aspects as of the internal psychic countries. From birth, relying on the biological, in the needs and experience of dependence, the human being organizes his psyche establishing limits between his inner world and external reality. Among the baby's first acquisitions, the ability to be alone will be the precursor of the space of intimacy that will accompany him throughout his life, and will be an inevitable and necessary element to support the identity transformations, both corporal and psychic, of the adolescent process. Aspects related to the experience of intimacy in situations of loneliness and the experience of sharing it are also addressed, including the therapeutic relationships with their specificity during adolescence