Characterizing the mental health and functioning of Canadian respiratory therapists during the COVID-19 pandemic.

Introduction: Healthcare professionals (HCPs) appear to be at increased risk for negative psychological outcomes [e.g. depression, anxiety, post-traumatic stress disorder (PTSD), moral distress] and associated impacts on functioning throughout the COVID-19 pandemic. HCPs working on designated COVID-19 units may be further impacted than their colleagues not on these units given added demands of patient care and risk of contracting COVID-19. Little is known, however, about the mental health and functioning of specific professional groups beyond nurses and physicians, including respiratory therapists (RTs), over the course of the pandemic. Accordingly, the purpose of the present study was to characterize the mental health and functioning of Canadian RTs and compare profiles between RTs working on and off designated COVID-19 units.Methods: Canadian RTs completed an online survey between February and June 2021, including demographic information (e.g. age, sex, gender,) and measures of depression, anxiety, stress, PTSD, moral distress and functional impairment. Descriptive statistics, correlation analyses and between-groups comparisons were conducted to characterize RTs and compare profiles between those on and off COVID-19 units.Results: Two hundred and eighteen (N = 218) RTs participated in this study. The estimated response rate was relatively low (6.2%) Approximately half of the sample endorsed clinically relevant symptoms of depression (52%), anxiety (51%) and stress (54%) and one in three (33%) screened positively for potential PTSD. All symptoms correlated positively with functional impairment (p's < .05). RTs working on COVID-19 units reported significantly greater patient-related moral distress compared to those not on these units (p < .05).Conclusion: Moral distress and symptoms of depression, anxiety, stress and PTSD were prevalent among Canadian RTs and were associated with functional impacts. These results must be interpreted with caution given a low response rate, yet raise concern regarding the long-term impacts of pandemic service among RTs.

Research on RTs' mental health prior to and during the COVID-19 pandemic is scant, especially in comparison to other HCPs.RTs in the present study reported experiencing moral distress and clinically significant symptoms of depression, anxiety and PTSD, with associated functional impairment.One in three RTs screened positive for likely PTSD on the PCL-5.There is a need to provide RTs with adequate mental health supports and to understand the long-term impacts of pandemic service among RTs.

Rol del terapeuta respiratorio en la prevención de neumonía asociada al ventilador / The respiratory therapist's role in the prevention of ventilator-associated pneumonia

Los Terapeutas respiratorios juegan un papel importante en la prevención de la neumonía asociada al ventilador, esta enfermedad es la infección hospitalaria más común en la unidad de cuidados intensivos (UCI) y la principal causa de muerte. Objetivo: Describir el rol del terapeuta respiratorio en la prevención de neumonía asociada al ventilador. Materiales y métodos: Este artículo fue realizado bajo los parámetros de la revisión documental, de nivel descriptivo, monográfico. La técnica aplicada fue el fichaje bibliográfico y el análisis sistemático de los documentos encontrados en la web. Resultados: Gracias a la revisión, análisis y síntesis de la bibliografía se obtuvo como resultado que la higiene de las manos, sumado a medidas específicas de prevención no farmacológicas, como elevación de la cabecera, manejo de presión del neumotaponamiento, aseo de la cavidad oral, aspiración y manejo de secreciones, así como estrategias para conservar la nutrición integral, son medidas simples y con buenos resultados en la prevención de la NAVM. Conclusiones: El rol del terapista respiratorio en la prevención de neumonía asociada al ventilador es cumplir con el tratamiento no farmacológico para el bienestar del paciente. Estas acciones van desde el acompañamiento hasta el lavado de manos adecuado antes y después de la atención(AU)

Respiratory therapists play an important role in the prevention of ventilator-associated pneumonia, which is the most common hospital-acquired infection in the intensive care unit (ICU) and the leading cause of death. Objective: To describe the role of the respiratory therapist in the prevention of ventilator-associated pneumonia. Materials and methods: This article was carried out under the parameters of a descriptive, monographic, documentary review. The technique applied was the bibliographic file and the systematic analysis of the documents found on the web. The results: According the review, analysis and synthesis of the literature, it was found that hand hygiene, together with specific non-pharmacological prevention measures, such as head elevation, pneumotapon pressure management, oral cavity cleaning, secretion aspiration and management, as well as strategies to maintain integral nutrition, are simple measures with good results in the prevention of VAP. Conclusions: The role of the respiratory therapist in the prevention of ventilator-associated pneumonia is to comply with non-pharmacological treatment for the patient's well-being. These actions range from accompaniment to proper hand washing before and after care(AU)

Competências essenciais ao terapeuta cognitivo-comportamental / Essential skills for the cognitive-behavioral therapist / Habilidades esenciales para elterapeuta cognitivo conductual

O presente estudo tem como objetivo realizar uma revisão integrativa da literatura latino-americana acerca de quais são as competências essenciais para um terapeuta cognitivo-comportamental, visto que as pesquisas na região são escassas e o desenvolvimento de competências profissionais fortalece a prática clínica. Foi realizado um levantamento bibliográfico por meio do mapeamento do que se tem publicado nas bases de dados PsycINFO, LILACS, SciELO e PePSIC. Foram incluídos na síntese qualitativa final oito artigos. As competências essenciais foram categorizadas em competências analíticas, sociais, instrumentais e de autoconhecimento e autorreflexão. Entre os principais achados estão as competências essenciais descritas nos artigos. Dentre estas, considera-se que a maior contribuição foi em relação às competências sociais, como uma competência inespecífica ou geral, necessária a todas as psicoterapias independentemente da orientação teórica de base. O presente estudo visou contribuir com a temática, visto que os estudos em âmbito nacional e latino-americano são escassos. (AU)

There is a shortage of studies on essential skills for a cognitive-behavioral therapist in Latin America, so this study aims to conduct an integrative review of the existing literature in the region, since the development of professional skills is essential to strengthen clinical practice. A bibliographic survey was performed by mapping what has been published in the PsycINFO, LILACS, Scielo, and Pepsic databases. Eight articles were included in the final qualitative synthesis. Core competencies were categorized into analytical, social, instrumental, self-knowledge, and self-reflection skills. The main findings comprise the essential skills described in the articles. Among these, it is considered that the greatest contribution was in relation to social competencies, as a non-specific or general competence, necessary to all psychotherapies regardless of the basic theoretical orientation. (AU)

Este estudio tuvo como objetivo realizar una revisión integradora de la literatura latinoamericana sobre cuáles son las competencias esenciales para un terapeuta cognitivo conductual, dado que la investigación en la región es insuficiente y el desarrollo de habilidades profesionales fortalece la práctica clínica. Se realizó una encuesta bibliográfica mediante el mapeo de lo publicado en las bases de datos PsycINFO, LILACS, Scielo y Pepsic. Se incluyeron ocho artículos en la síntesis cualitativa final. Las competencias básicas se caracterizaron en habilidades analíticas, sociales, instrumentales, de autoconocimiento y autorreflexión. En los principales hallazgos se encuentran las habilidades esenciales descritas en los artículos. Entre estos, se considera que la mayor contribución fue con relación a las competencias sociales, como una competencia no específica o general, necesaria para todas las psicoterapias, independientemente de la orientación teórica básica. Este estudio tuvo como objetivo contribuir a la temática, ya que los estudios a nivel nacional y latinoamericano son escasos. (AU)

El rol del terapeuta ocupacional: la inclusión laboral y la Ley 21 015 en Chile / Role of the occupational therapist: the labour inclusion and Law 21 015 in Chile

INTRODUCCIÓN: Desde la terapia ocupacional se identifica una serie de labores imprescindibles en la intermediación laboral de personas en situación de discapacidad (PeSD). La incorporación de estos elementos, en la Ley chilena N°21.015, es de especial importancia para lograr una inclusión laboral efectiva. OBJETIVO: Relevar el rol que cumplen los terapeutas ocupacionales en la inclusión laboral de PeSD en el marco de la Ley 21.015. MÉTODO: Esta investigación es de tipo cualitativa, específicamente un estudio descriptivo y prospectivo, en el que se utilizó un diseño fenomenológico hermenéutico. La muestra fue no probabilística por redes, en la que se entrevistó a siete terapeutas ocupacionales con experiencia en inclusión laboral de PeSD. RESULTADOS: Los terapeutas ocupacionales reconocen tareas de su rol en cada una de las etapas del proceso de intermediación laboral, las cuales varían según el usuario objetivo del profesional y el origen de la discapacidad de la persona incluida. Los entrevistados consideran que la Ley 21.015 no contempla la mayoría de estas tareas y tampoco establece cuáles son los profesionales capacitados para la realización de este proceso. Los terapeutas ocupacionales justifican la relevancia de su rol en base a la mirada holística que poseen de la persona y el conocimiento especializado de la discapacidad. CONCLUSIONES: La terapia ocupacional es una profesión relevante en todo el proceso de intermediación laboral. Este proceso es una labor que desempeña un equipo transdisciplinario y, en el que, además, es de suma importancia que sea un trabajo intersectorial para que se logren resultados eficaces y satisfactorios.

INTRODUCTION: Due to occupational therapy, a series of essential tasks in the labour intermediation of people with disabilities are identified. The incorporation of the elements listed in the Chilean Law 21.015 is of vital importance to achieve an effective labour inclusion. OBJECTIVE: Demonstrate the role that occupational therapists play in relation to the labour inclusion of people with disabilities, regarding the Law 21.015. METHOD: This is a qualitative investigation, specifically a descriptive and prospective study, in which a hermeneutics phenomological design was used. The sample was not probabilistic in networks, in which seven experienced occupational therapists in labour inclusion of people with disabilities were interviewed RESULTS: Occupational therapists recognized the importance of their role in each stage of the labour intermediation, which varies between the target users of the professional and the origen of the disability of the person. The persons interviewed recognized that most of these tasks are not included in the Law 21.015, nor does it establish which are the qualified professionals for the realization of this process. Based on the holistic view of the person and their specific knowledge about disability, occupational therapists justify the importance of their role. CONCLUSION: The occupational therapist is of vital importance in all the processes involving labour intermediation. The process is carried by a transdisciplinary team, where by effective and satisfactory results are achieved thanks to intersectorial work.

An integrative review of assessments used in occupational therapy interventions for children with cerebral palsy / Revisão integrativa de avaliações utilizadas em intervenções de terapia ocupacional para crianças com paralisia cerebral

Abstract Introduction: Children with cerebral palsy (CP) experience a wide range of deficits and symptoms. When undergoing occupational therapy (OT) interventions, it is essential that the OT select assessments that can accurately reflect the outcome measures of the targeted domains. Objective: To identify the assessment tools most frequently reported in research studies as measures for OT interventions when treating children with CP. Method: Pubmed and Ovid databases were systematically searched by using key terms "cerebral palsy," "assessments," and "occupational therapy". Assessment tools were explored and extracted from articles contingent on the following inclusion criteria: (1) children birth to 18 years diagnosed with cerebral palsy; (2) use of assessment(s) as a measure of OT intervention; (3) published in English between 2007 and 2017. In the preliminary search, Pubmed yielded 151 records and Ovid yielded 571. Out of these, only 76 met the inclusion criteria. From the remaining 76 articles, a total of 88 assessment tools were retrieved and included in this literature review. Results: Ten assessments were found to be of importance based on frequency of use. The Assisting Hand Assessment (AHA) and Pediatric Evaluation of Disability Inventory (PEDI) were the most commonly used. Conclusion: This study helps to determine which assessments are frequently used in OT practice with children with CP. The findings of this study play an important role in addressing the challenge of assessment selection faced by occupational therapists and provide a basis for future research to expand on with regards to treating children with CP.

Resumo Introdução: Crianças com Paralisia Cerebral (PC) apresentam uma ampla gama de déficits e sintomas. Quando submetidos a intervenções de terapia ocupacional (OT), é essencial que as avaliações utilizadas reflitam com precisão as medidas de resultados dos domínios visados. Objetivo: Identificar os instrumentos de avaliação mais utilizados como medidas para intervenções no TO no tratamento de crianças com PC. Método: Bancos de dados Pubmed e Ovid foram sistematicamente pesquisados ​​usando os termos-chave "paralisia cerebral", "avaliações" e "terapia ocupacional". Avaliaçoes foram exploradas e extraídas de artigos contingentes aos seguintes critérios de inclusão: (1) crianças de até 18 anos com diagnóstico de paralisia cerebral; (2) uso da(s) avaliação (ões) como medida de intervenção do TO; (3) publicado em inglês entre 2007 e 2017. Na pesquisa preliminar, foram encontrados 151 artigos em Pubmed e 571 em Ovid. Destes, apenas 76 foram inlcuidos devido aos critérios de inclusão. Dos 76 artigos restantes, um total de 89 avaliaçoes foram encontradas e incluídas nesta revisão da literatura. Resultados: Dez avaliações foram consideradas importantes com base na frequência de uso. A "Assisting Hand Assessment" (AHA) e o Inventário de Avaliação Pediátrica de Incapacidade (PEDI) foram os mais utilizados. Conclusão: Os achados deste estudo desempenham um papel importante no e do desafio de seleção de avaliação enfrentado pelos terapeutas ocupacionais e fornecem uma base para futuras pesquisas para expandir no que diz respeito ao tratamento de crianças com PC.

"It's both a strength and a drawback." How therapists' personal qualities are experienced in their professional work.

Objective: The aim of this study was to gain knowledge about how the integration of personal and professional experiences affects therapeutic work. Method: Therapists (N = 14) who had been recommended by their leaders at their individual workplaces were interviewed twice with semi-structured qualitative interviews, which were then subjected to thematic and Interpretative Phenomenological Analysis. Results: All the therapists in the sample described their personal qualities as an experienced tension between their personal strengths and vulnerabilities in the therapeutic setting. This tension came to expression through four subordinate themes: (a) The tension between perceiving oneself as a helper while dealing with one's own needs for attention and care; (b) The tension between the ability for embodied listening to the patient while tuning into oneself; (c) The tension between staying present while handling aggression and rejection from clients; and (d) The tension in striving for a constructive balance between closeness and distance. Conclusion: The results point to ways in which the personal selves of the therapists may affect their professional role performance. Drawing upon previous research and literature on the topic, the paper discusses how therapists' personal qualities are experienced as affecting their work and suggests several implications for psychotherapy training and practice.

Psychotherapist trainees' professional self-doubt and negative personal reaction: Changes during cognitive behavioral therapy and association with patient progress.

OBJECTIVE: This study examined psychotherapist trainees' experiences of "professional self-doubt" (PSD) and "negative personal reaction" (NPR) during cognitive behavioral therapy (CBT) and their associations with patients' symptoms and interpersonal problems. METHOD: Forty therapists treating 621 patients were analyzed. Patients' symptoms and interpersonal problems were collected repeatedly during therapy. Data about patients' interpersonal problems were available only for 106 patients and 18 therapists. Therapists' difficulties were assessed as trait-based (one assessment across all patients) and as state-based (repeated assessments for each individual patient) difficulties. Multilevel models were performed. RESULTS: None of the trait-based difficulties correlated with the change of the patients' symptoms. Yet, more NPR at the trait-level predicted a more favorable change, whereas higher PSD at the trait-level showed an opposite effect on change of patients' interpersonal problems. Regarding state-based difficulties, PSD as well as NPR decreased significantly over the course of CBT. Patients whose therapists' experienced PSD to increase during CBT were at risk of a less favorable patient progress regarding symptoms, whereas the change of interpersonal problems was not significantly associated with changes in therapists' difficulties. CONCLUSION: Patients' progress is associated with therapists' experiences of difficulties. Yet, trait- and state-based difficulties lead to different results.

Identidad profesional en Terapia Ocupacional: una revisión bibliográfica desde España / Professional identity in Occupational Therapy: a bibliographical review from Spain / Identidade profissional na Terapia Profissional: uma revisão bibliográfica desde Espanha

Contexto: La identidad profesional en Terapia Ocupacional (TO) ha atravesado por diversos procesos de construcción y reconstrucción a lo largo de su historia. En el camino, se han registrado una serie de discusiones al respecto y aún el debate se encuentra abierto. Objetivo: Identificar el estado actual de las discusiones sobre la identidad profesional en la TO, a nivel internacional y en España. Metodología: se realiza una revisión bibliográfica narrativa en diferentes bases de datos y otras fuentes de publicación de la profesión. Resultados y análisis: Tras la obtención del material bibliográfico (24 artículos), se agruparon los documentos por temas, identificándose las siguientes categorías: (a) contribuciones de la identidad profesional a la disciplina (10 artículos); (b) conceptualizaciones de la identidad profesional en TO (11 artículos); (c) identidad profesional en España (4 artículos). Conclusiones: se pone de manifiesto la importancia de fomentar la adquisición y construcción de una identidad profesional durante el periodo de formación universitaria. Se hace necesaria la realización de investigaciones que permitan comprender mejor cómo se construye la identidad profesional en diferentes contextos y la influencia de la formación universitaria en este proceso.

Context: Professional identity in Occupational Therapy (OT) has undergone various construction and reconstruction processes throughout its history. Along the way, there have been a number of discussions on the subject and the debate is still open. Objective: To identify the current state of discussions on professional identity in OT, at an international and Spanish level. Methodology: a narrative revision is done in different databases and other publication sources of the profession. Results and analysis: After obtaining the bibliographic material, the documents were grouped by topic, identifying the following categories: (a) contributions of the professional identity to the discipline; (b) conceptualizations of professional identity in OT; (c) professional identity in Spain. Conclusions: the importance of promoting the acquisition and construction of a professional identity during the period of university education is highlighted. It is necessary to carry out research to better understand how professional identity is constructed in different contexts and the influence of university education in this process.

Contexto: A identidade profissional em Terapia Ocupacional (TO) passou por vários processos de construção e reconstrução ao longo de sua história. Ao longo do caminho, houve várias discussões sobre o assunto e o debate ainda está aberto. Objetivo: Identificar o estado atual das discussões sobre identidade profissional em OT, no nível internacional e espanhol. Metodologia: uma revisão narrativa é feita em diferentes bancos de dados e outras fontes de publicação da profissão. Resultados e análise: após a obtenção do material bibliográfico, os documentos foram agrupados por tópico, identificando as seguintes categorias: (a) contribuições da identidade profissional para a disciplina; (b) conceituais de identidade profissional em TO; (c) identidade profissional na Espanha. Conclusões: a importância de promover a aquisição e construção de uma identidade profissional durante o período de ensino universitário é destacada. É necessário realizar pesquisas para entender melhor como a identidade profissional é construída em diferentes contextos e a influência da educação universitária neste processo.

THERAPISTS' EXPERIENCES OF MOTHER-INFANT PSYCHOANALYTIC TREATMENT: A QUALITATIVE STUDY.

As part of a larger research project in Sweden, a qualitative study investigated psychotherapists' experiences of mother-infant psychoanalysis (MIP). A randomized controlled trial compared two groups of mother-infant dyads with psychological problems. One had received Child Health Center care, and the other received MIP. Previous articles on long-term effects have found that mothers who had received MIP were less depressed throughout a posttreatment period of 3½ years, and their children showed better global functioning and psychological well-being. The present study's objectives were to describe the therapist's experiences of MIP and deepen the understanding of the MIP process. Six months after treatment began, all therapists were interviewed. Transcribed interviews with therapists from 10 (of 33 total) MIP treatments were randomly selected and analyzed in detail by thematic analysis. Therapists worked successfully with mother and infant together and found different ways of cooperation during MIP sessions. Therapists reported overall positive experiences; however, in cases where mothers needed more personal attention, it would be important to adapt the method to them.

Terapeutas ocupacionales: influencia del género en su desempeño laboral / Occupational therapies: gender influence in their work performance

Esta investigación se fundamenta desde una perspectiva y enfoque de género. Su objetivo fue analizar la influencia del género en el desempeño laboral de los Terapeutas Ocupacionales en la ciudad de Temuco, basándose en las percepciones y vivencias de dichos profesionales. La metodología utilizada corresponde al enfoque cualitativo, utilizando como sustento teórico la fenomenología. La muestra del estudio fue intencional y estuvo constituida por 10 profesionales, siendo elnúmero de hombres y mujeres iguales en cantidad. Se utilizó la entrevista semiestructurada como instrumento de recolección de datos analizando la información obtenida a través del análisis de contenido y análisis de discurso. Los tópicos abordados consideran la relación entre trabajo y género y hacen referencia a: diferencias salariales, costos laborales, manejo de poder y estatus de minoría. Los resultados obtenidos señalan que existe influencia del género en el desempeño laboral de los Terapeutas Ocupacionales en todas las determinantes analizadas, principalmente en costos laborales y estatus de minoría. Con respecto al impacto en el desempeño existen opiniones divididas, y a que el 80 por ciento de la muestra femenina considera que existe influencia de género en el desempeño laboral, frente al 60 por ciento masculino que no visualiza influencias en su quehacer determinados por la variable de género. Sin embargo, se hace necesario destacar que lo anterior no está determinado por la disciplina, sino que por las construcciones culturales de la sociedad, por lo que debemos ser más críticos con los fenómenos derivados de género, considerando que es una categoría de análisis inherente al ser humano.

This research is based on a gender perspective and approach. Its objective was to analyze the gender’s influence on the performance of Occupational Therapists’s work in the city of Temuco, based on the perceptions and experiences of these professionals. The methodology used corresponds to the qualitative approach, using the phenomenology as theoretical support. The sample of the study was intentional and was constituted by 10 professionals, being the number of men and women equal in quantity. The semi - structured interview was used as an instrument of data collection by analyzing the information obtained through content analysis and discourse analysis. The topics covered consider the relationship between work and gender and refer to: wage differences, labor costs, power management and minority status. The results obtained indicate that there is gender influence in the occupational therapists’ workperformance in all the determinants analyzed, mainly in labor costs and minority status. With regard to the impact on performance, there are divided opinions, since 80 percent of the female sample considers that there is gender influence in the labor performance, compared to the male 60 percent that does not visualize influences in their work determined by the gender variable. However, it is necessary to emphasize that the above is not determined by the discipline, but by the cultural constructions of the society, reason why we must be more critical with the phenomena derived from gender, considering that it is a category of analysis inherent to the human being.

Building Alliances with (In)Voluntary Clients: A Study Focused on Therapists' Observable Behaviors.

This study aimed to compare therapists' observable behaviors to promote alliances with involuntary and voluntary clients during brief family therapy. The therapists' contributions to fostering alliances were rated in sessions 1 and 4 using videotapes of 29 families who were observed in brief therapy. Using the System for Observing Family Therapy Alliances, trained raters searched for specific therapist behaviors that contributed to or detracted from the four alliance dimensions: engagement in the therapeutic process, an emotional connection with the therapist, safety within the therapeutic system, and a shared sense of purpose within the family. The results showed that when working with involuntary clients, therapists presented more behaviors to foster the clients' engagement and to promote a shared sense of purpose within the family. However, in the fourth session, the therapists in both groups contributed to the alliance in similar ways. The results are discussed in terms of (a) the therapists' alliance-building behaviors, (b) the specificities of each client group, and (c) the implications for clinical practice, training, and research.

Significados das práticas dos "Terapeutas da Alegria" sobre pacientes adultos internados em um hospital universitário / Meanings of the "Therapists of Joy" practices on adult patients admitted to a university hospital

Diversas ações de humanização da assistência hospitalar têm sido adotadas mundialmente no intuito de superar a técnica e a objetividade impostas pelo modelo biomédico hegemônico, que já não contempla as necessidades de saúde atuais. Exemplo disso, a palhaçoterapia representa um paradoxo que possibilita, dentre outros efeitos, a ressignificação do ambiente hospitalar a partir das vivências individuais proporcionadas pelas intervenções realizadas pelos palhaços nos hospitais. O projeto de extensão Terapeutas da Alegria (TA) é um exemplo dessa prática. Adotando uma abordagem qualitativa, a partir da interpretação dos textos obtidos nas entrevistas aos pacientes e observações, este estudo busca compreender os significados das intervenções dos TA realizadas durante visitas à pacientes adultos internados em um hospital universitário. As categorias que emergiram da codificação dos dados e sua análise apontaram que a palhaçoterapia provoca ressignificação do ambiente hospitalar e do próprio ser, agora no papel de paciente. Também apontaram reflexões sobre a relação com o desconhecido e particularidades e desafios da interação de palhaços de hospital com pacientes adultos, no intuito de gerar sentimentos favoráveis à recuperação da saúde. Esse estudo demonstra a complexidade do tema e a importância de pesquisas futuras de uma prática já tão difundida no contexto brasileiro e mundial.(AU)

Several humanization actions have been adopted in hospital care settings worldwide in order to overcome technique and objectivity imposed by hegemonic biomedical model, which no longer address current health needs. Example of this, clown therapy consist in a paradox that enables, among other effects, to reframe hospital setting from individual experiences provided by interventions with clowns. The extension project Therapists of Joy (TA) is an example of this practice. Adopting a qualitative approach, based on the interpretation of the texts obtained in interviews with patients and observations of visits, this study aims to understand the meanings of TA interventions made during visits to adult patients admitted to a university hospital. Categories emerged from data codification and their analysis pointed out that clown therapy causes re-signification of the hospital environment and of the being itself, now in a patient's role. It also pointed out reflections on the relationship with the unknown and particularities of adult patients' interaction with clowns, in order to generate favorable feelings for health recovery. This study demonstrates the complexity of the theme and the importance of future research of a practice already so widespread in Brazilian and around the world.(AU)

O discurso construcionista social na prática clínica de terapeutas familiares / Social constructionist discourse in the clinical practice of family therapists / El discurso construccionista social en la práctica clínica de terapeutas familiares

O campo da terapia familiar (TF) é composto por diferentes propostas teóricas e epistemológicas. Recentemente, o construcionismo social tem contribuído para a configuração de novas práticas em TF, levando a uma maior ênfase nos processos de comunicação no contexto terapêutico. O objetivo deste estudo é investigar a difusão do construcionismo entre terapeutas familiares brasileiros. Participaram 14 terapeutas, homens e mulheres, psicólogos, que realizam atendimentos de famílias e são professores em cursos de formação em TF. Realizamos entrevistas semiestruturadas, que foram gravadas em áudio e transcritas literalmente. A partir das propostas construcionistas para a pesquisa científica, realizamos análise temática das informações. Nas cinco temáticas construídas, discutimos como os participantes descrevem o construcionismo e as implicações advindas em sua prática clínica. Concluímos que a difusão deste está atrelada à atribuição de utilidade aos conceitos teóricos, constituindo-se em porta de entrada para reflexões acerca da atuação clínica e cujas contribuições agregam novos elementos ao posicionamento do terapeuta.

The field of family therapy (FT) consists of different theoretical and epistemological proposals. More recently, social constructionism has contributed for the creation of new practices in FT, leading to an emphasis on the communication processes in the therapeutic context. This study aims to comprehend dissemination forms of social constructionist discourse among Brazilian family therapists. We interviewed 14 family therapists, men and women, psychologists, who work with family counseling, and are responsible for teaching social constructionism in FT training institutes. All the interviews were recorded and literally transcribed. A thematic analysis was carried out based on social constructionism contributions for research practice. Throughout these themes, we discuss the participants' definitions of social constructionism and its implications for their positioning in daily practice. We conclude that the dissemination of social constructionist discourse is related to the utility that family therapists attach to these theoretical contributions, turning them into resources for their positioning as family therapists.

El campo de la terapia familiar (TF) es constituido por diferentes propuestas teóricas y epistemológicas. Recientemente, el construccionismo social ha contribuido a la configuración de nuevas prácticas en TF, lo que lleva a un mayor énfasis en los procesos de comunicación en el contexto terapéutico. El objetivo del estudio es investigar la difusión del construccionismo entre terapeutas familiares brasileños. Participaron del estudio catorce terapeutas, hombres y mujeres, psicólogos, que realizan atendimientos familiares y son profesores en cursos de formación en TF. Se realizó entrevistas semiestructuradas, que fueron grabadas en audio y transcritas literalmente. Desde las propuestas construccionistas para la investigación científica, realizamos análisis temático de las informaciones. En los cinco temas creados, discutimos como los participantes describen el construccionismo y las implicaciones desde su práctica clínica. Se concluye que la difusión del construccionismo está vinculada a la distribución de utilidad a los conceptos teóricos, constituyéndose en puerta de entrada para reflexiones acerca de la actuación clínica y cuyas contribuciones abarcan nuevos elementos al posicionamiento del terapeuta.

Presentación de una guía para la observación y clasificación de la conducta verbal de los Terapeutas / Presentation of an observation and classification guide of therapists' verbal behavior

El artículo presenta una guía de observación y clasificación de la conducta verbal de los terapeutas, la Guía de Observación de Terapeutas Aiglé (GOTA-v). Se revisan los estudios sobre la variable del terapeuta, especialmente el Estilo Personal y sus procedimientos de evaluación. Este nuevo instrumento fue aplicado a la transcripción de 44 sesiones de 12 terapeutas de Argentina con diferente orientación teórico-técnica y distinto grado de experiencia (bajo, medio y alto). Se delimitaron los textos de las sesiones en unidades de análisis y se clasificaron esas unidades con categorías pertenecientes a tres clases de actos de habla: Preguntas, afirmaciones e indicaciones. Se calculó el índice de acuerdo inter jueces de Kappa para cada clase. Se discuten los alcances y limitaciones del instrumento y sus posibilidades para la investigación en psicoterapia.

The article presents an observation and classification guide of therapists' verbal behavior, the Aiglé Therapists Observation Guide (ATOG-v). Studies on the therapist variables together with the assessment procedures are revisited. This new instrument was applied to the transcription of 44 sessions of 12 therapists in Argentina with different theoretical-technical orientation and different levels of experience (low, moderate and high). The session texts were delimited into analysis units and these units were classified with categories pertaining three types of speech acts: questions, statements and indications. The Kappa inter-judges index was applied for each class. The scope and limitations of the instrument and its possibilities for psychotherapy research are presented.

El desvalimiento en la adolescencia / The helplessness in adolescence

En el comentario sobre este caso se toman en cuenta diversas variables; los riesgos de la paciente, en relación a sus experiencias tempranas y a su estadía en varios hogares que de algún modo reproducen el desvalimiento temprano; los riesgos para la terapeuta en relación a los efectos transferenciales y también las características de las personas que ocupan diversos lugares en la Institución. Asimismo, se señalan algunas cuestiones de orden social que van en detrimento de las posibilidades de generar espacios apropiados, cuidado por el personal que trabaja en estas instituciones que permitan abordar con mayor eficacia las problemáticas de los padecientes.

The commentary on this case are taken into account various variables, therisk of the patient, in relation to their early experiences and stay in various “homes” that somehow reproduce the early helplessness; therapist risksregarding the effects transference and also the characteristics of the peoplewho occupy different places in the institution. It also identifies some socialissues that are detrimental to the chances of generating appropriate spaces, care for the staff working in these institutions to more effectively address the problems of the patients.

Estilo terapêutico e orientação teórica: estudo comparativo com o Therapeutic Identity Questionnaire / Therapeutic style and theoretical orientation: comparative study using the Therapeutic Identity Questionnaire / Estilo terapéutico y orientación teórica: estudio comparativo con el Therapeutic Identity Questionnaire

O estudo das variáveis relativas ao terapeuta é um tema de relevância empírica no âmbito da investigação sobre o processo e resultados terapêuticos. O objetivo deste estudo é verificar se há diferenças nas respostas dadas às três subescalas em avaliação na versão em língua portuguesa do Therapeutic Identity Questionnaire (ThId) (fatores curativos, estilo terapêutico e pressupostos de base) em função da orientação teórica, dos anos de experiência e da realização de terapia pessoal dos 34 terapeutas em estudo, e avaliar as características psicométricas do instrumento. Em conclusão, a versão em língua portuguesa do ThId apresenta boas qualidades psicométricas e revelase útil para detectar diferenças de estilo e atitude terapêutica entre clínicos de diferentes orientações teóricas, mesmo em amostras dereduzida dimensão.

The study of therapist variables is a matter of empirical relevance in the realm of the research on therapeutic process and outcome.The goal of this study is to ascertain the differences regarding the responses given to the 3 subscales of the Portuguese version of the Therapeutic Identity Questionnaire (ThId) in evaluation (curative factors, therapeutic style and basic assumptions) in relation to theoretical orientation, years of experience and previous personal therapy among the 34 therapists enrolled in the study, along side the psychometric evaluation of the instrument. In conclusion, the Portuguese version of ThId displays good preliminary psychometricqualities and empirical use fulness to capture differences in style and attitude between clinicians of different theoretical models, evenin reduced samples.

El estudio de las variables relacionadas con el terapeuta es tema de prominencia empírica en la investigación sobre proceso y resultados terapéuticos. El objetivo de este estudio es verificar si hay diferencias en las respuestas a las tres subescalas en evaluación en la versión en lengua portuguesa del Therapeutic Identity Questionnaire (ThId) (factores curativos, estilo terapéutico y supuestos de base) atendiendo ala orientación teórica, años de experiencia y realización de terapia personal de los 34 terapeutas participantes, y evaluar las características psicométricas del instrumento. En conclusión, la versión en lengua portuguesa del ThId tiene buenas propiedades psicométricas y esútil para detectar diferencias de estilo y actitud terapéutica entre clínicos de diferentes orientaciones teóricas, incluso en muestras dedimensión reducida.

Estilo terapêutico e orientação teórica: estudo comparativo com o Therapeutic Identity Questionnaire / Therapeutic style and theoretical orientation: comparative study using the Therapeutic Identity Questionnaire / Estilo terapéutico y orientación teórica: estudio comparativo con el Therapeutic Identity Questionnaire

O estudo das variáveis relativas ao terapeuta é um tema de relevância empírica no âmbito da investigação sobre o processo e resultados terapêuticos. O objetivo deste estudo é verificar se há diferenças nas respostas dadas às três subescalas em avaliação na versão em língua portuguesa do Therapeutic Identity Questionnaire (ThId) (fatores curativos, estilo terapêutico e pressupostos de base) em função da orientação teórica, dos anos de experiência e da realização de terapia pessoal dos 34 terapeutas em estudo, e avaliar as características psicométricas do instrumento. Em conclusão, a versão em língua portuguesa do ThId apresenta boas qualidades psicométricas e revelase útil para detectar diferenças de estilo e atitude terapêutica entre clínicos de diferentes orientações teóricas, mesmo em amostras dereduzida dimensão.(AU)

The study of therapist variables is a matter of empirical relevance in the realm of the research on therapeutic process and outcome.The goal of this study is to ascertain the differences regarding the responses given to the 3 subscales of the Portuguese version of the Therapeutic Identity Questionnaire (ThId) in evaluation (curative factors, therapeutic style and basic assumptions) in relation to theoretical orientation, years of experience and previous personal therapy among the 34 therapists enrolled in the study, along side the psychometric evaluation of the instrument. In conclusion, the Portuguese version of ThId displays good preliminary psychometricqualities and empirical use fulness to capture differences in style and attitude between clinicians of different theoretical models, evenin reduced samples.(AU)

El estudio de las variables relacionadas con el terapeuta es tema de prominencia empírica en la investigación sobre proceso y resultados terapéuticos. El objetivo de este estudio es verificar si hay diferencias en las respuestas a las tres subescalas en evaluación en la versión en lengua portuguesa del Therapeutic Identity Questionnaire (ThId) (factores curativos, estilo terapéutico y supuestos de base) atendiendo ala orientación teórica, años de experiencia y realización de terapia personal de los 34 terapeutas participantes, y evaluar las características psicométricas del instrumento. En conclusión, la versión en lengua portuguesa del ThId tiene buenas propiedades psicométricas y esútil para detectar diferencias de estilo y actitud terapéutica entre clínicos de diferentes orientaciones teóricas, incluso en muestras dedimensión reducida.(AU)

Surpresas e analogias na construção e continuidade dos grupos / Sorpresas y analogías en la construcción y continuidad de los grupos / Surprises and analogies in the establishment and continuity of groups

Neste artigo, a autora apresenta as dificuldades e surpresas ocorridas nos grupos funcionando em consultório privado ao longo de anos. Nesta apresentação são mostradas as angústias dos pacientes que entram nos grupos, que saem dos grupos e os que se mantêm, assim como o processo de transformação da coordenadora com o passar dos anos de experiência. A ênfase recai sobre as surpresas que esta atividade apresenta, assim como suas vicissitudes. É trazida uma reflexão sobre o processo alquímico existente nos processos grupais.(AU)

The author emphasizes difficulties and surprises of groups that have functioned in private practice for years. Anguishes of patients who join, leave or continue in the groups are presented, as well as the process of transformation underwent by the coordinator during these years of practice. Furthermore, it provides a reflection upon the alchemical process that occurs in groups.(AU)

La autora presenta las dificultades y sorpresas de los grupos funcionando en una clínica particular a lo largo de los años años. En esta presentación se pueden mostrar las preocupaciones de los pacientes que entran en los grupos, que salen de los grupos y los que se permanecen; así como las de la coordinadora. El objetivo mayor es compartir las sorpresas que esta actividad presenta, sus características especiales y una reflexión sobre el proceso alquímico existente para la autora, contenido en los procesos grupales.(AU)

Surpresas e analogias na construção e continuidade dos grupos / Sorpresas y analogías en la construcción y continuidad de los grupos / Surprises and analogies in the establishment and continuity of groups

Neste artigo, a autora apresenta as dificuldades e surpresas ocorridas nos grupos funcionando em consultório privado ao longo de anos. Nesta apresentação são mostradas as angústias dos pacientes que entram nos grupos, que saem dos grupos e os que se mantêm, assim como o processo de transformação da coordenadora com o passar dos anos de experiência. A ênfase recai sobre as surpresas que esta atividade apresenta, assim como suas vicissitudes. É trazida uma reflexão sobre o processo alquímico existente nos processos grupais.

The author emphasizes difficulties and surprises of groups that have functioned in private practice for years. Anguishes of patients who join, leave or continue in the groups are presented, as well as the process of transformation underwent by the coordinator during these years of practice. Furthermore, it provides a reflection upon the alchemical process that occurs in groups.

La autora presenta las dificultades y sorpresas de los grupos funcionando en una clínica particular a lo largo de los años años. En esta presentación se pueden mostrar las preocupaciones de los pacientes que entran en los grupos, que salen de los grupos y los que se permanecen; así como las de la coordinadora. El objetivo mayor es compartir las sorpresas que esta actividad presenta, sus características especiales y una reflexión sobre el proceso alquímico existente para la autora, contenido en los procesos grupales.

Avaliação fisiológica e comportamental de cães utilizados em terapia assistida por animais (TAA) / Phyisiological and behavioral assessment in dogs used in Animal-Assisted Therapy (AAT)

Realizou-se a observação comportamental de nove cães terapeutas (oito da raça Labrador Retriever e um Golden Retriever), dosaram-se cortisol sérico e salivar, aferiram-se a temperatura retal, a pressão arterial sistólica e as frequências cardíaca e respiratória nos seguintes momentos: M0 (média de três avaliações do cão em repouso) e em M1, M2 e M3 (imediatamente antes, imediatamente após e decorridas 24h das atividades de terapia assistida por animais - TAA), respectivamente. Não houve diferença significativa quanto às características estudadas (P>0,05), exceto pela temperatura, que foi mais elevada em M1 e M2 do que em M0 (P=0,009). A avaliação comportamental, realizada de maneira descritiva, não apresentou alteração negativa. Houve diferença significativa quanto à concentração de cortisol sérico entre os momentos M1 e M3 (P=0,071), e não ocorreu diferença da concentração do cortisol salivar entre os quatro momentos (P=0,746). As alterações observadas foram atribuídas à contenção e à manipulação dos animais e não desencadearam desconforto físico ou estresse dignos de nota em cães.

Behavioral observation of nine therapist dogs (eight Labrador Retrievers and one Golden Retriever) was performed and serum and salivar cortisol dosage, rectal temperature, systolic blood pressure and heart and respiratory rates were measured and evaluated at the following moments: M0 (average of three evaluations of the dog at rest) and M1, M2 e M3 (immediately before, at the end and 24 hours after the AAT activities, respectively). There was no significant difference in the parameters between the moments (P>0.05) except for temperature, which was higher in M1 and M2 than M0 (P=0.009). The behavioral assessment was conducted in a descriptive way and didn't present a negative effect. There was significant difference when comparing the serum cortisol levels between M1 and M3 (P=0.0712). There wasn't asignificant difference in salivary cortisol levels when comparing the values of the four moments (P=0.7458). The observed alterations are probably related to the containment and handling of animals, demonstrating that the therapy doesn't have a negative effect on dogs.