RESUMO
OBJECTIVE: Individuals with eating disorders (EDs) often do not receive evidence-based care, such as interpersonal psychotherapy (IPT), partly due to lack of accessible training in these treatments. The standard method of training (i.e., in-person workshops) is expensive and time consuming, prompting a need for more scalable training tools. The primary aim of this pilot and open trial was to examine the effects of an IPT online training platform on training outcomes (i.e., IPT fidelity, knowledge, and acceptance) and, secondarily, whether online training was different from in-person training (using a comparative sample from a separate study) in terms of training outcomes and patient symptoms. METHOD: Participants were therapists (N = 60) and student patients (N = 42) at 38 college counseling centers. Therapists completed baseline questionnaires and collected data from a student patient with ED symptoms. Therapists then participated in an IPT online training program and completed post-training assessments. RESULTS: Following online training, acceptance of evidence-based treatments, therapist knowledge of IPT, therapist acceptance of IPT, and treatment fidelity increased; acceptance of online training was high at baseline and remained stable after training. Using the 90% confidence interval on outcome effect sizes, results suggested IPT online training was not different from in-person training on most outcomes. Results are based on 60% of therapists who originally enrolled due to high dropout rate of therapist participants. CONCLUSIONS: Findings from this preliminary pilot study support the use of IPT online training, which could increase access to evidence-based ED treatment and improve patient care. PUBLIC SIGNIFICANCE: Lack of accessible therapist training has contributed to many therapists not delivering, and therefore many patients not receiving, evidence-based treatment. This study evaluated a highly disseminable online training and compared outcomes to traditional in-person training and found that training and patient outcomes were not different. Online training has the potential to enhance access to evidence-base care, which could in turn optimize patient outcomes.
Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos , Psicoterapia Interpessoal , Humanos , Projetos Piloto , Feminino , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Adulto , Masculino , Adulto Jovem , Internet , Inquéritos e Questionários , Psicoterapia/educação , Psicoterapia/métodosRESUMO
Persons with dependent personality disorder (DPD) have difficulties describing their inner world, and in realizing their negative ideas about the self, such as being weak, unworthy or powerless are just ideas. As a consequence, they tend to over-rely on others and may lose control over their emotions. Treating these persons can gain benefits from including body-focused techniques as they can promote a) awareness of internal states, b) better emotion regulation, c) the capacity to consider their negative ideas about themselves as not necessarily true, and d) gain power of and agency. We will describe the therapist used body-focused techniques in the context of Metacognitive Interpersonal Therapy when treating Lia, a 40-year-old woman suffering from DPD who also suffered from generalized anxiety disorder and had difficulties in making autonomous choices. She had a romantic relationship with a man she described as distant and judgmental so she felt lonely and not entitled to express her discomfort or capable to break up. The therapist used body-focused techniques, together with behavioural exposure, mindfulness and guided imagery, to let Lia be more aware of her thoughts and feelings, and then to regulate affects and realize she had previously capacities. At therapy termination anxiety diminished and she could break up with the partner and start a new one where she felt free to express herself. We suggest how bodily-focused techniques can be used to enhance therapy effectiveness in DPD.
Assuntos
Transtorno da Personalidade Dependente , Metacognição , Humanos , Feminino , Adulto , Metacognição/fisiologia , Transtorno da Personalidade Dependente/terapia , Transtorno da Personalidade Dependente/psicologia , Psicoterapia Interpessoal/métodos , Relações InterpessoaisRESUMO
OBJECTIVE: Interpersonal psychotherapy (IPT) has been proposed for prevention of excess weight gain among adolescents with loss-of-control (LOC) eating. Mixed findings from a trial testing this conjecture warrant elucidation of potential outcome predictors. The therapeutic alliance (adolescent-facilitator emotional bond and task collaboration) may be important for IPT but has received little attention in weight-related interventions. This study evaluated associations of adolescent-reported therapeutic alliance during IPT with weight- and eating-related outcomes. METHODS: Secondary analyses of a randomized controlled trial were conducted to compare group IPT to health education (HE) for preventing excess weight gain among 113 girls (ages 12-17) with body mass index (BMI) at the 75th to 97th percentile and LOC eating. BMI and LOC eating were measured at baseline, 12 weeks (postintervention), and 1 year. Multilevel modeling was used to test associations between change in therapeutic alliance (from session 1 to session 12) and changes in weight- and eating-related outcomes (from postintervention to 1 year). Analyses were controlled for therapeutic alliance after session 1 and for baseline and postintervention outcome values; group assignment (IPT vs. HE) was a moderator. RESULTS: Increases in emotional bond were associated with decreased weight and with greater decreases in number of LOC eating episodes at 1 year in the IPT group (p<0.05) and with weight gain in the HE group (p<0.05). Greater task collaboration was related to greater weight gain at 1-year follow-up, regardless of group assignment (p<0.05). CONCLUSIONS: The association of therapeutic alliance during IPT with weight and LOC eating outcomes among adolescent girls merits further investigation.
Assuntos
Psicoterapia Interpessoal , Aliança Terapêutica , Adolescente , Feminino , Humanos , Índice de Massa Corporal , Psicoterapia , Aumento de Peso , Criança , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Depression is a serious illness; approximately 40%-60% of patients develop relapse, and this risk increases up to 90%. Interpersonal psychotherapy (IPT) is an effective method to minimize depressive symptoms and relapse. OBJECTIVES: This randomized control trial study is designed to assess the effectiveness of IPT on depression symptom reduction and relapse prevention. MATERIALS AND METHODS: Three hundred depressed patients from a selected psychiatric hospital in UP, India, were recruited by a simple random sampling technique that randomly allocated 150 participants to the experimental group and 150 to the control group by tossing a coin. Depressive symptoms were assessed using the Hamilton Depression Rating Scale, which has 17 items. On the 2nd day of the trial, the experimental group received IPT. It helped the participants recognize their emotions and urge themselves to express them, both of which had a direct positive impact on their sad mood. The IPT efficacy assessment was done at the end of the 4 weeks of the intervention, and the relapse prevention assessment was undertaken 4 months later. The control group was kept with the actual treatment modalities and psychoeducation sessions, and they were assessed in the same way as the experimental group. RESULTS: Findings illustrated that the reduction of depressive symptoms with (t = 33.61) (P = 0.0000) and relapse prevention with (t = 2.7484) (P = 0.0067) are significant, respectively. Furthermore, symptom reduction and relapse prevention had an association with some demographical data at P < 0.05, 0.001. CONCLUSION: IPT is an effective intervention for reducing depressive symptoms and preventing relapse.
Assuntos
Depressão , Psicoterapia Interpessoal , Prevenção Secundária , Humanos , Masculino , Feminino , Adulto , Prevenção Secundária/métodos , Índia , Depressão/prevenção & controle , Depressão/terapia , Pessoa de Meia-Idade , Adulto Jovem , Escalas de Graduação PsiquiátricaRESUMO
Importance: Extensively researched, exposure-focused therapies have dominated the treatment of posttraumatic stress disorder (PTSD). No treatment benefits all patients. Interpersonal psychotherapy (IPT), a nonexposure, affect-focused treatment, has emerged over 2 decades as an alternative evidence-based PTSD intervention.Objective: This narrative review critically assesses IPT outcomes for PTSD. Time limited IPT focuses on affect toleration and the interpersonal consequences of trauma rather than on reconstructing the trauma narrative and exposure to traumatic cues.Evidence Review: The author searched the outcome literature on IPT for adults with syndromal PTSD and drew upon personal involvement in studies since 2001. Subsyndromal PTSD studies and 1 adolescent trial were excluded.Findings: Thirteen published studies of IPT targeted PTSD in individual and group formats for 592 civilians (n = 8, 6 randomized controlled trials [RCTs]) and 187 military veterans (n = 5, 1 RCT). Some trials had methodological limitations. IPT surpassed outcomes of waiting lists and other weak controls and was noninferior to evidence-based PTSD treatments including Prolonged Exposure (n = 2) and sertraline (n = 1). Depression and other outcomes improved. The RCTs demonstrate IPT efficacy for PTSD and allow preliminary exploration of outcome mediators and moderators and differential therapeutics.Conclusion: While the number of studies remains limited, research by multiple investigators in differing populations supports the efficacy of IPT as a non trauma-focused PTSD treatment and justifies its inclusion in PTSD treatment guidelines. More research is necessary to determine how IPT compares to exposure-focused treatments in patient preference, attrition, and response for PTSD comorbid with major depression or due to sexual trauma.
Assuntos
Psicoterapia Interpessoal , Transtornos de Estresse Pós-Traumáticos , Humanos , Transtornos de Estresse Pós-Traumáticos/terapia , AdultoRESUMO
BACKGROUND: Depression continues to be an ongoing threat to adolescent well-being with Black adolescents being particularly vulnerable to greater burdens of depression as well as lower mental health service utilization. Black adolescents are likely to have untreated depression due to social network influences, varied perceptions of services and providers, or self-stigma associated with experiencing depressive symptoms. Furthermore, if or when treatment is initiated, low engagement and early termination are common. To address this gap, a trial is being conducted to preliminarily test the effectiveness of an engagement intervention targeting Black adolescents with depression in school mental health services in New York City. METHODS: A total of 60 Black middle and high school adolescents displaying depressive symptoms are equally randomized (based on school site) to the treatment arms. Both trial arms deliver Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), a time-limited, evidence-based treatment for depression. Additionally, one arm pairs IPT-A with a brief, multi-level engagement intervention, the Making Connections Intervention (MCI), involving adolescents, caregivers, and clinicians. Outcomes of interest are group differences in depression and suicide ideation, adolescent and caregiver engagement, and mental health service use. DISCUSSION: This trial will serve as an efficacy assessment of the MCI among a sample of Black adolescent students with depressive symptoms. Clinical and implementation results will be used to inform future research to further test the MCI intervention in a larger sample. TRIAL REGISTRATION: Registered by ClinicalTrials.gov on May 3, 2019, identifier: NCT03940508.
Assuntos
Psicoterapia Interpessoal , Serviços de Saúde Mental , Serviços de Saúde Mental Escolar , Humanos , Adolescente , Depressão/diagnóstico , Depressão/prevenção & controle , Prevenção do Suicídio , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: There are 10 million admissions to U.S. prisons and jails each year. More than half of those admitted have mental health problems. The goal of this article is to inform: (1) implementation of evidence-based mental health treatments in prisons and jails, an important effort that needs more evidence to guide it; (2) psychotherapy and interpersonal psychotherapy (IPT) training efforts, especially in low-resource settings. METHODS: A randomized hybrid effectiveness-implementation trial of group IPT for major depressive disorder (MDD) in state prisons found that IPT increased rates of MDD remission and lowered posttraumatic stress disorder symptoms relative to prison treatment as usual. The trial used prison counselors, only some of whom had prior psychotherapy training/experience, to deliver IPT. IPT treatment adherence was high (96%), but trial training and supervision were too costly to be scalable outside the trial. The current article reports results from a planned qualitative analysis of 460 structured implementation and supervision documents in that trial to describe training and supervision processes and lessons learned, inform training recommendations, and facilitate future work to optimize training and supervision for under-resourced settings. RESULTS: Themes identified in implementation and supervision process notes reflected: work on psychotherapy basics (reflective listening, focusing on emotions, open-ended questions, specific experiences), IPT case conceptualization (forming a conceptualization, what is and is not therapeutic work, structure and limit setting, structure vs. flexibility), IPT techniques (enhancing social support, role plays, communication analysis), psychotherapy processes (alliance repair, managing group processes), and managing difficult situations (avoidance, specific clients, challenging work settings). Counselors were receptive to feedback; some relied on study supervisors for support in managing stressful prison working conditions. CONCLUSIONS: Findings can be used to make future training and supervision more efficient. Based on our results, we recommend that initial and refresher training focus on IPT case conceptualization, steps for addressing each IPT problem area, and reflective listening. We also recommend supervision through at least counselors' first two rounds of groups. More low-cost, scalable training methods are needed to get mental health treatment to individuals who need it most, who are often served in challenging, low-resource settings such as prisons. This is a mental health access and equity issue. TRIAL REGISTRATION: The trial was registered at clinicaltrials.gov (NCT01685294).
Assuntos
Transtorno Depressivo Maior , Psicoterapia Interpessoal , Prisões , Humanos , Transtorno Depressivo Maior/terapia , Masculino , Feminino , Adulto , Psicoterapia/métodos , Prisioneiros/psicologia , Resultado do TratamentoRESUMO
BACKGROUND: This study is a cost-effectiveness study of two implementation strategies designed to train therapists in college and university counseling centers to deliver interpersonal psychotherapy. Costs of implementing a train-the-trainer (TTT) strategy versus an expert consultation strategy were estimated, and their relative effects upon therapist outcomes were calculated and compared. METHODS: Twenty four counseling centers were recruited across the United States. These centers were randomized to either a TTT (experimental) condition, in which an in-house therapist trained other center therapists, or an expert consultation condition, in which center therapists participated in a workshop and received 12 months of ongoing supervision. The main outcome was therapist fidelity (adherence and competence) to interpersonal psychotherapy, assessed via audio recordings of therapy sessions, and analyzed using linear mixed models. Costs of each condition were quantified using time-driven activity-based costing methods, and involved a costing survey administered to center directors, follow up interviews and validation checks, and comparison of time tracking logs of trainers in the expert condition. Mean costs to produce one therapist were obtained for each condition. The costs to produce equivalent improvements in therapist-level outcomes were then compared between the two conditions. RESULTS: Mean cost incurred by counseling centers to train one therapist using the TTT strategy was $3,407 (median = $3,077); mean cost to produce one trained therapist in the control condition was $2,055 (median = $1,932). Therapists in the TTT condition, on average, demonstrated a 0.043 higher adherence score compared to therapists in the control condition; however, this difference was not statistically significant. For the competence outcome, effect size for therapists in the TTT condition was in the large range (1.16; 95% CI: 0.85-1.46; p < .001), and therapists in this condition, on average, demonstrated a 0.073 higher competence score compared to those in the expert consultation condition (95% CI, 0.008-0.14; p = .03). Counseling centers that used the TTT model incurred $353 less in training costs to produce equivalent improvements in therapist competence. CONCLUSIONS: Despite its higher short run costs, the TTT implementation strategy produces greater increases in therapist competence when compared to expert consultation. Expanding resources to support this platform for service delivery can be an effective way to enhance the mental health care of young people seeking care in college and university counseling centers. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02079142.
Assuntos
Análise Custo-Benefício , Humanos , Estados Unidos , Psicoterapia Interpessoal/métodos , Feminino , Masculino , Serviços de Saúde para Estudantes/economia , Universidades , Aconselhamento/economia , Aconselhamento/métodos , Adulto , Encaminhamento e Consulta/economia , Ciência da ImplementaçãoRESUMO
This paper describes the decade-long, successful experience of developing a group therapy training program for mental health professionals in China. The perspectives of two Western group therapy instructors/supervisors and of a Chinese colleague who participated broadly in the program are described. We explore our understanding of Western ideas about group therapy and how these were experienced in the Chinese context. We address the opportunities that emerged at the interface of two very different cultures, and the challenges of translating and integrating Western group therapy principles and practices within a culture with a very different history and worldview.
Assuntos
Psicoterapia Interpessoal , Psicoterapia de Grupo , Humanos , Psicoterapia , Povo Asiático , ChinaRESUMO
Investigating the mechanisms through which psychotherapy brings about desired change can inform efforts to improve therapies. We applied meta-analytic structural equation modeling (MASEM) to assess putative change mechanisms for cognitive behavioral therapy (CBT) as mediators of youth depression treatment outcome. Then, we tested whether candidate mediators (CMs) showed evidence of treatment-specificity to CBT versus interpersonal psychotherapy (IPT). Literature searches identified 34 randomized trials (27 CBT, 6 IPT, 1 CBT/IPT, 3,868 participants, published 1982-2020) that measured seven CMs: negative cognition, social engagement, family functioning, pleasant activity engagement, problem solving, reframing, or avoidance. We assessed mediational pathways and whether posttreatment CMs mediated treatment effects on posttreatment depression symptoms, covarying pretreatment CMs, and symptoms. Treatment type was tested as a moderator of mediational pathways. Results show that negative cognition (24 trials) and pleasant activities (3 trials) mediated depression symptom outcome in CBT. Social engagement and family functioning showed stronger mediation in IPT (5 and 6 trials) than in CBT (14 and 13 trials). We conclude that negative cognition is a robust mediator of CBT but may not be treatment-specific; pleasant activities may also be a mediator of CBT. However, the lack of treatment or mediation effects involving problem solving and reframing contradicts CBT theory. In contrast, social and family mechanisms appear to be IPT-specific mediators. These conclusions are provisional due to small samples examining IPT and several CMs, limitations in CM measurement (i.e., posttreatment retrospective report), and assumptions of MASEM-and will need to be confirmed when more and better evidence accumulates. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Assuntos
Terapia Cognitivo-Comportamental , Psicoterapia Interpessoal , Análise de Classes Latentes , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Terapia Cognitivo-Comportamental/métodos , Adolescente , Criança , Depressão/terapia , Depressão/psicologia , Resultado do Tratamento , Transtorno Depressivo/terapia , Transtorno Depressivo/psicologiaRESUMO
En este trabajo se presentan recortes del caso clínico de una joven de 14 años, en tratamiento durante dos años y medio, encuadrado en el consultorio privado. Se abordan los acontecimientos que generaron quiebres en la continuidad de su historia, y cómo, a través del trabajo con los adultos referentes y con la joven, se habilitaron las posibilidades de un rearmado psíquico que apuntó a la subjetivación de su historia, y a posibilitar las condiciones psíquicas para el ingreso a la adolescencia AU
Cet ouvrage présente des coupures d'un cas clinique d'une jeune fille de 14 ans, en traitement depuis deux ans et demi, cadré dans le cabinet privé. Les événements qui ont généré des ruptures dans la continuité de son histoire sont abordés et comment, à travers le travail avec les références adultes et avec la jeune femme, les possibilités d'un réarmement psychique visant à la subjectivation de son histoire ont été activées et ont permis au conditions psychologiques d'entrée à l'adolescence AU
This work presents clippings of a clinical case of a 14-year-old girl, during twoand a half years of treatment, framed in the private office. The events that generated breaks in the continuity of her story are addressed, and how, through work with the adult references and with the young woman, the possibilities of a psychic rearming that aimed at the subjectivation of her story were enabled, and to enable the psychological conditions for entering adolescence AU
Este trabalho apresenta recortes do caso clínico de uma jovem de 14 anos, durante doisanos e meio de tratamento, enquadrado em consultório particular. São abordados os acontecimentos que geraram rupturas na continuidade de sua história e como, por meio do trabalho com as referências adultas e com a jovem, foram viabilizadas as possibilidades de um rearmamento psíquico que visava à subjetivação de sua história, e possibilitar a condições psicológicas para entrar na adolescencia AU
Assuntos
Humanos , Feminino , Adolescente , Identificação Social , Psicoterapia Interpessoal/métodos , Relações Profissional-Família , Estrutura Familiar/históriaRESUMO
Este trabajo se apoya en los conceptos contrato narcisista primario y secundario para dar cuenta del proceso de filiación y afiliación de la paciente (caso de Agustina) AU
This work relies on the concepts of primary and secondary Narcissistic Contract to understand the process of affiliation and filiation of the patient (Agustina Ìs case) AU
Ce travail s'appuie sur les concepts de contrat narcissique primaire et secondaire pour rendre compte du processus de filiation et du processus d Ìadhésiondu patient (cas d ÌAgustina) AU
Este trabalho baseia-se nos conceitos de contrato narcísico primário e secundário para dar conta do processo de filiação e afiliaçãodo paciente (caso de Agustina) AU
Assuntos
Humanos , Feminino , Adolescente , Família/psicologia , Identificação Psicológica , Psicoterapia Interpessoal/métodosRESUMO
Este artigo refere-se à parte de uma pesquisa de doutorado, realizada em hospital de alta complexidade do Sistema Único de Saúde, cujos participantes são os profissionais de saúde. O objetivo deste artigo é analisar o potencial da abordagem das narrativas como método de pesquisa e intervenção nos serviços de saúde, traçando aproximações com a teoria psicanalítica. Sua relevância no campo da Saúde Pública está calcada no reconhecimento do papel do sujeito como agente de mudanças. O texto divide-se em duas partes: na primeira, explora as especificidades do trabalho na área da saúde, o paradigma da saúde pública no que concerne à gestão e possíveis contribuições da clínica ampliada para esse modelo. Na segunda parte, analisa o uso das narrativas como método de pesquisa nesse campo e as aproximações conceituais entre a narrativa em Walter Benjamin e a psicanálise em Freud. Busca na literatura referências sobre experiências análogas que fundamentem a proposta ora realizada e conclui pela importância de, no momento atual, apostar na força germinativa das narrativas como fonte criativa de novas formas de cuidar.(AU)
This article derives from a PhD research conducted with health professionals at a high-complexity public hospital from the Brazilian Unified Health System (SUS). It analyzes the potential of the narrative as a research and intervention method in health services, outlining approximations with psychoanalysis. In the field of Public Health, the narrative approach acknowledges the individual as an agent of change. The text is divided into two parts. The first presents an overview of the peculiarities involved in healthcare, the Public Health paradigm regarding service management and possible contributions from the expanded clinic to this model. The second analyzes the use of narratives as a research method in this field and the conceptual approximations between Benjamin's narrative and Freud's psychoanalysis. It searches the literature for references on similar experiences to support the present proposal and concludes by highlighting the importance of betting on the creative power of narratives as a source for new ways to care.(AU)
Este artículo es parte de una investigación doctoral, realizada con los profesionales de la salud de un hospital de alta complejidad del Sistema Único de Salud de Brasil. Su propósito es analizar el potencial del enfoque en narrativas como método de investigación e intervención en los servicios de salud, esbozando aproximaciones entre las narrativas y la teoría del psicoanálisis. Su relevancia en el campo de la salud pública se basa en el reconocimiento del rol del sujeto como agente de cambio. El texto se divide en dos partes: La primera investiga las especificidades del trabajo en el área de la salud, el paradigma de la salud pública en la gestión de los servicios y las posibles contribuciones de la clínica ampliada a este modelo. En la segunda parte, analiza el uso de narrativas como método de investigación en este campo y las aproximaciones conceptuales entre la narrativa de Walter Benjamin y el psicoanálisis de Freud. Este estudio busca en la literatura referencias sobre experiencias similares que apoyen la propuesta ahora realizada y concluye con la importancia de, en el momento actual, apostar por el poder de las narrativas como fuente creadora de nuevas formas de cuidar.(AU)
Assuntos
Humanos , Masculino , Feminino , Psicanálise , Políticas, Planejamento e Administração em Saúde , Narração , Pesquisa Qualitativa , Educação Profissional em Saúde Pública , Políticas , Ansiedade , Dor , Parapsicologia , Personalidade , Política , Interpretação Psicanalítica , Psicologia , Psicopatologia , Psicoterapia , Administração em Saúde Pública , Qualidade da Assistência à Saúde , Regionalização da Saúde , Mudança Social , Condições Sociais , Fatores Socioeconômicos , Sociologia , Superego , Avaliação da Tecnologia Biomédica , Inconsciente Psicológico , Comportamento , Sintomas Comportamentais , Cooperação Técnica , Esgotamento Profissional , Atividades Cotidianas , Saúde Mental , Doença , Técnicas Psicológicas , Estratégias de Saúde , Eficiência Organizacional , Vida , Equidade em Saúde , Modernização Organizacional , Tecnologia Biomédica , Vulnerabilidade a Desastres , Cultura , Capitalismo , Valor da Vida , Morte , Depressão , Economia , Ego , Gestão de Ciência, Tecnologia e Inovação em Saúde , Atividades Científicas e Tecnológicas , Funções Essenciais da Saúde Pública , Humanização da Assistência , Ética Institucional , Tecnologia da Informação , Terapia Narrativa , Determinantes Sociais da Saúde , Integralidade em Saúde , Assistência Ambulatorial , Trauma Psicológico , Terapia Focada em Emoções , Estresse Ocupacional , Fascismo , Esgotamento Psicológico , Psicoterapia Interpessoal , Angústia Psicológica , Fatores Sociodemográficos , Vulnerabilidade Social , Ocupações em Saúde , Acessibilidade aos Serviços de Saúde , História , Direitos Humanos , Id , Serviços de Saúde Mental , Princípios MoraisRESUMO
Esta pesquisa qualitativa objetivou compreender, fenomenologicamente, a experiência vivida por psicoterapeutas e crianças no acontecer clínico da ludoterapia humanista. Foram realizados 26 encontros dialógicos individuais com nove psicoterapeutas e sete crianças, registrados pela pesquisadora na forma de Narrativas Compreensivas que incluíram suas impressões impactadas subjetivamente pelas falas e expressões corporais dos participantes. A análise fenomenológica culminou com a escrita de uma Narrativa Síntese. Os resultados indicam que a relação psicoterapêutica é percebida como: facilitadora do crescimento psicológico da criança; intensificadora do fluxo de mudanças ao dinamizar os processos pessoais infantis; geradora de motivação na criança para a relação interpessoal, a partir do envolvimento subjetivo do terapeuta; potencializadora da tomada de consciência com base na corporeidade; propiciadora da integração de experiências por meio do brincar; reveladora das singularidades individuais, catalisando o desenvolvimento; e, por fim, benéfica à atualização de significados e sentidos da experiência pessoal e relacional. Evidenciou-se, entre os psicoterapeutas, uma concepção da ludoterapia humanista que prioriza a compreensão dirigida ao estilo próprio de cada cliente em relação aos modos de sentir e expressar-se no mundo e à estruturação do processo psicoterapêutico a partir do relacionamento com a criança. Concluiu-se, assim, que a experiência desse tipo de relação interpessoal facilita a constituição na criança de singularidades que imprimem um sentido existencial próprio ao seu mundo de relações e historicidade. A relevância do processo psicoterapêutico para o crescimento psicológico da criança apresentou-se também pelo seu caráter psicoprofilático, reverberado no encadeamento de processos associados à experiência pessoal dela.(AU)
This qualitative research aimed to understand, phenomenologically, the lived experience of psychotherapists and children in the clinical event of humanistic play therapy. A total of 26 individual dialogical encounters were held with nine psychotherapists and seven children, registered in the form of Comprehensive Narratives by the researcher, which included her subjectively impacted impressions about the participants' speeches and body expressions. The phenomenological analysis culminated in a Synthesis Narrative. The results demonstrate that the psychotherapeutic relationship is perceived as: facilitating the child's psychological growth; intensifying the flow of change by streamlining children's personal processes; generating motivation for the child to get involved with interpersonal relationship, based on the subjective involvement of the therapist; potentiating awareness raising based on the corporeality; enabling the integration of experiences by playing; revealing the uniqueness, catalyzing development; and, finally, benefiting the updating of meanings and senses of personal and relational experience. A conception of humanistic play therapy became evident among the psychotherapists, which prioritizes the understanding directed to the own way of each client regarding how to feel and express themselves in the world and the structuring of the psychotherapeutic process based on the relationship with the child. Thus, it was concluded that the experience of this interpersonal relationship facilitates the constitution in the child of singularities that bring their own existential meaning to their world of relationships and historicity. The relevance of the psychotherapeutic process for the child's psychological growth was also shown by the psycho-prophylactic character reverberated in the processes associated with the child's personal experience.(AU)
Esta investigación cualitativa tuvo por objetivo comprender, fenomenológicamente, la experiencia vivida por psicoterapeutas y niños en ludoterapia de orientación humanista. La investigadora desarrolló 26 conversaciones dialógicas individuales con nueve psicoterapeutas y siete niños, registradas como narrativas comprensivas que incluyeron sus impresiones impactadas subjetivamente por los discursos y expresiones corporales de los participantes. El análisis fenomenológico culminó con una síntesis narrativa. Los resultados demuestran que la relación psicoterapéutica se percibe como facilitadora del crecimiento psicológico del niño; intensificadora del flujo de cambio, optimizando su procesos personales; generadora de motivación para que el niño se involucre en la relación interpersonal a partir del envolvimiento subjetivo del terapeuta; potenciadora de la toma de conciencia a partir de la corporeidad; propiciadora de la integración de las experiencias por medio del juego; reveladora de singularidades individuales al catalizar el desarrollo; y beneficiosa para actualizar los significados y sentidos de la experiencia personal e relacional. Entre los psicoterapeutas se hizo evidente una concepción de ludoterapia humanista que prima por comprender la forma propia del cliente de sentirse y expresarse y la estructuración del proceso psicoterapéutico a partir de la relación con el niño. Se concluyó que la vivencia de este tipo de relación facilita la constitución en el niño de singularidades que le aportan un sentido existencial a su mundo de relación e historicidad. La relevancia del proceso psicoterapéutico para el crecimiento psicológico también se mostró por su carácter psicoprofiláctico, que reverberó en la cadena de procesos asociados con la experiencia personal del niño.(AU)
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Ludoterapia , Fenômenos Psicológicos , Psicologia Clínica , Individualidade , Aprendizagem , Ansiedade , Pediatria , Personalidade , Arte , Arteterapia , Resolução de Problemas , Psicologia , Psicologia Social , Agitação Psicomotora , Psicoterapia , Recreação , Atenção , Instituições Acadêmicas , Autocuidado , Autoimagem , Sinais e Sintomas , Comportamento Social , Esportes , Terapêutica , Terapia Comportamental , Estimulação Acústica , Timidez , Luto , Caricaturas como Assunto , Divórcio , Criança , Comportamento Infantil , Transtornos do Comportamento Infantil , Desenvolvimento Infantil , Psicologia da Criança , Educação Infantil , Saúde da Criança , Cognição , Violência Doméstica , Transtornos da Comunicação , Ciência Cognitiva , Vida , Disciplinas e Atividades Comportamentais , Desenho , Literatura Infantojuvenil , Criatividade , Afeto , Vulnerabilidade a Desastres , Terapias Sensoriais através das Artes , Confiança , Pesquisa Qualitativa , Agressão , Depressão , Crescimento e Desenvolvimento , Dislexia , Educação , Emoções , Empatia , Gravuras e Gravação , Ética , Centros de Convivência e Lazer , Relações Familiares , Resiliência Psicológica , Teoria Social , Experiências Adversas da Infância , Separação da Família , Respeito , Psicoterapia Interpessoal , Angústia Psicológica , Funcionamento Psicossocial , Terapia Gestalt , Diversidade, Equidade, Inclusão , Capacidades de Enfrentamento , Desenvolvimento Humano , Humanismo , Identificação Psicológica , Aculturação , Relações Interpessoais , Transtornos da Linguagem , Deficiências da Aprendizagem , Musicoterapia , Psicoterapia Centrada na Pessoa , Apego ao ObjetoRESUMO
A recomendação ética do psicólogo para intervir criticamente sobre a demanda vai de encontro com a tarefa de diagnosticar atos de Alienação Parental e, num sentido amplo, com a judicialização das relações privadas. A genealogia de Foucault consiste num método capaz de lançar luz sobre as práticas de poder na base dos discursos relacionados ao tema da alienação parental. O eufemismo pedagógico empregado para designar as sanções da lei tem como finalidade estratégica o convencimento a respeito de supostos benefícios da tutela sobre as famílias, ao mesmo tempo em que lhes são atribuídas alguma patologia disfuncional. Numa perspectiva crítica, a assimetria de gêneros corresponde às relações de poder presentes no problema da alienação parental. Por fim, a inversão dos critérios de identificação da alienação parental revela o distanciamento entre o ideal normativo e a realidade da ruptura conjugal e familiar, apontando para a importância de práticas de cuidado e assistência em vez de judicativas e punitivas.(AU)
The psychologist's ethical recommendation to critically intervene on the demand goes against the task of diagnosing acts of Parental Alienation (AP) and, in a broad sense, with the judicialization of private relations. Foucault's genealogy consists of a method able to shed on the power practices on the basis of discourses related to the theme of Parental Alienation. The pedagogical euphemism used to designate the sanctions of the law has the strategic purpose of convincing about the supposed benefits of guardianship over families, while attributing some dysfunctional pathology to them. From a critical perspective, gender asymmetry corresponds to the power relations present in the Parental Alienation problem. Finally, the inversion of the Parental Alienation's identification criteria reveals the gap between the normative ideal and the reality of marital and family disruption, pointing to the importance of care and assistance practices instead of judicative and punitive ones.(AU)
La recomendación ética del psicólogo de intervenir críticamente sobre la demanda va en contra de la tarea de diagnosticar actos de Alienación Parental (AP) y, en un sentido amplio, con la judicialización de las relaciones privadas. La genealogía de Foucault consiste en un método capaz de arrojar luz sobre las prácticas del poder a partir de discursos relacionados con el tema de la Alienación Parental. El eufemismo pedagógico que se utiliza para designar las sanciones de la ley tiene el propósito estratégico de convencer sobre los supuestos beneficios de la tutela sobre las familias, atribuyéndoles alguna patología disfuncional. Desde una perspectiva crítica, la asimetría de género corresponde a las relaciones de poder presentes en el problema de la Alienación Parental. Finalmente, la inversión de los criterios de identificación de la Alienación Parental revela la brecha entre el ideal normativo y la realidad de la ruptura conyugal y familiar, señalando la importancia de las prácticas de cuidado y asistencia en lugar de las judicativas y punitivas.(AU)
Assuntos
Humanos , Masculino , Feminino , Justiça Social , Custódia da Criança , Genealogia e Heráldica , Jurisprudência , Ansiedade , Comportamento Paterno , Privação Paterna , Psicanálise , Psicologia Social , Política Pública , Repressão Psicológica , Transtorno do Deficit de Atenção com Hiperatividade , Relações entre Irmãos , Ciências Sociais , Seguridade Social , Fatores Socioeconômicos , Sociologia , Terapêutica , Comportamento e Mecanismos Comportamentais , Abuso Sexual na Infância , Adaptação Psicológica , Divórcio , Casamento , Maus-Tratos Infantis , Defesa da Criança e do Adolescente , Desenvolvimento Infantil , Educação Infantil , Proteção da Criança , Saúde Mental , Saúde da Criança , Saúde da Família , Responsabilidade Legal , Poder Familiar , Negociação , Violência Doméstica , Cônjuges , Feminismo , Intervenção em Crise , Família Monoparental , Cultura , Estado , Responsabilidade Civil , Ministério Público , Denúncia de Irregularidades , Dissidências e Disputas , Depressão , Transtornos Dissociativos , Emprego , Conflito Familiar , Relações Familiares , Pai , Resiliência Psicológica , Perdão , Sexismo , Abuso Físico , Violência de Gênero , Opressão Social , Estereotipagem de Gênero , Experiências Adversas da Infância , Separação da Família , Tristeza , Psicoterapia Interpessoal , Traição , Abuso Emocional , Modelos Biopsicossociais , Equidade de Gênero , Papel de Gênero , Apoio Familiar , Estrutura Familiar , Manobra Psicológica , Desamparo Aprendido , Direitos Humanos , Relações Interpessoais , Deficiências da Aprendizagem , Privação Materna , Mães , Transtorno Dissociativo de Identidade , Apego ao ObjetoRESUMO
ABSTRACT OBJECTIVE To show the implementation process of IPT-G in primary care, including facilitating and obstructing factors, implementation strategies, and training and supervision of primary care professionals. METHODS Quantitative (cross-sectional and longitudinal) analysis of pre and post-knowledge tests; qualitative analyses of the training courses; patient recruitment; conduction of IPT-G sessions; supervision of IPT-G therapists; application of a semi-structured questionnaire to assess, investigate, and develop strategies against the identified barriers. RESULTS About 120 clinicians answered the pre-test; 84 completed the post-test. Pre- and post-test scores of IPT-G knowledge were significantly different. Twenty initially trained clinicians completed additional supervision in IPT-G. Qualitative analysis identified twelve barriers and six facilitators to IPT-G implementation in individual, organizational, and systemic contexts. CONCLUSIONS Implementation of IPT-G in primary care is a complex process with several steps. In the first step, health professionals were successfully trained in IPT-G. However, subsequent steps were more complex. Therefore, careful planning of IPT-G implementation is essential to maximize the success of this innovation.
Assuntos
Humanos , Psicoterapia Interpessoal , Atenção Primária à Saúde , Brasil , Estudos Transversais , Inquéritos e QuestionáriosRESUMO
Este artículo describe el protocolo para evaluar intervenciones con adolescentes expuestos a violencia interpersonal y sigue los lineamientos de CONSORT (Shulz et al., 2010). El objetivo es evaluar la efectividad de dos modelos de intervención grupal (Terapia Cognitivo Conductual Centrada en el Trauma, TF-CBT y Terapia Interpersonal, IPT) en la estabilización del funcionamiento psicosocial de adolescentes. Método. Este es un ensayo controlado aleatorizado con tres grupos: dos grupos de intervención (TF-CBT e IPT) y un grupo de control activo (arteterapia). Los participantes serán 84 adolescentes entre 13 a 17 años que están en lista de programas especializados. Los participantes serán asignados a uno de los tres grupos y participarán en 12 sesiones de terapia grupal. Se evaluará el progreso de los participantes en sintomatología de estrés postraumático y depresión, problemas de autorregulación e interpersonales. Las medidas se administrarán antes del inicio de la intervención, en sesiones seis, siete, doce y dos meses después de finalizada la intervención. También se evaluará la adherencia a la intervención y su aceptabilidad por parte de los participantes. Discusión. Este estudio busca contribuir al desarrollo de intervenciones basadas en evidencia en Chile para mejorar el acceso a la intervención especializada. Registro del protocolo: 19/05/2021, código ISRCTN10290141.
This paper describes the protocol developed in Chile to evaluate interventions for adolescents exposed to interpersonal violence and follows CONSORT guidelines (Shulz et al., 2010). The objective is to evaluate the effectiveness of two group intervention models (Trauma Focused Cognitive Behavioral Therapy and Interpersonal Therapy) in stabilising the psychosocial functioning of adolescent participants. Methods/Design. It is a randomised controlled trial with three groups: two intervention groups (TF-CBT and IPT) and an active control group (art therapy). The participants will be eighty-four adolescents between 13 to 17 years old on the waiting list for treatment in specialist trauma services. Participants will be assigned to one of three groups and participate in 12 group therapy sessions. Participants' progress in post-traumatic stress and depression symptomatology, self-regulation and interpersonal problems will be assessed. Measures will be administered before the start of the intervention, in sessions six, seven, twelve and two months after the end of the intervention. Adherence to the intervention and its acceptability by the participants will also be evaluated. Discussion. This study seeks to contribute to developing scalable, evidence-based interventions in the Chilean context to improve access to specialist intervention. Trial Registration. 19/05/2021, code ISRCTN10290141.
Assuntos
Humanos , Adolescente , Psicoterapia de Grupo/métodos , Violência , Terapia Cognitivo-Comportamental , Chile , Projetos Piloto , Psicoterapia InterpessoalRESUMO
Resumen Los objetivos de este artículo fueron: (a) describir el perfil de Estilo Personal del Terapeuta (EPT) en dos grupos de psicólogos clínicos: uno que trabaja en instituciones de tratamiento de adicciones y otro no abocado específicamente a este campo; (b) comparar el posible efecto del enfoque teórico y los años de experiencia profesional sobre el EPT en cada grupo. Para ello se trabajó con una muestra de 429 psicólogos clínicos de Argentina divididos en dos grupos: Grupo Adicciones (n = 102) y Grupo Clínico (n = 327). Como instrumento se empleó el Cuestionario de Estilo Personal del Terapeuta. A nivel de resultados se obtuvieron diferencias significativas en la función de Involucración (p < .05), donde los terapeutas de adicciones obtuvieron puntajes superiores. Asimismo, se observaron diferencias entre ambos grupos de terapeutas según el enfoque teórico y correlaciones significativas con los años de experiencia profesional.
Abstract: The objectives of this study were: (a) to describe the profile of the Therapist's Personal Style (TPS) in two groups of clinical psychologists: one group working in drug addict institutions and the other group dedicated to general clinical treatment; (b) to compare the possible effect of the theoretical framework and the years of experience on the TPS in each group. For this purpose, a sample of 429 clinical psychologists from Argentina was divided into two groups: Addictions Group (n = 102) and Clinical Group (n = 327). The Therapeutic Personal Style Questionnaire was used as instrument. As a result, there were significant differences in the Engagement function (p < .05), higher among the therapists of drug addict patients. Likewise, differences between both groups of therapists were observed according to the theoretical approach as well as significant correlations with years of professional experience.
Assuntos
Humanos , Masculino , Feminino , Adulto , Psicologia/tendências , Terapeutas Ocupacionais/psicologia , Testes de Personalidade , Argentina , Psicoterapia , Psicoterapia InterpessoalRESUMO
Apresentaremos uma possível operacionalidade da Fenomenologia da Vida de Michel Henry e seu método em situações clínicas. Neste método investigamos o conceito desenvolvido por Michel Henry nesta fenomenologia denominado corpopropriação e a intuição reflexiva na compreensão e intervenção clínica. É a relação terapêutica em instituições de saúde que é colocada em primeiro plano, tanto nos cuidados a um paciente adulto com transtorno psiquiátrico quanto em grupo com crianças acolhidas. Verifica-se como os terapeutas se corpo-apropriam de seus pacientes e como estes se corpo-apropriam de seus sofrimentos nos cuidados clínicos, bem como o uso das reflexões intuitivas no diálogo. Os resultados nos mostram que um corpo doente pode ser humanizado na relação terapêutica e tem possibilidades de encarnar vivências, ampliando assim a mobilidade afetiva, do sofrer ao fruir de si. No entanto, se a relação não tiver sustentação e continuidade, dificilmente se consegue a estabilidade dessa transformação, mas deixa marcas enraizadas em cada encontro inter-humano.
We will present a possible operationalization of Michel Henry's Phenomenology of Life and his method in clinical situations. This method investigates the concept developed by Michel Henry in this phenomenology called corpspropriation and the reflexive intuition in the comprehension and clinical intervention. It is a therapeutic relationship in health institutions that is placed In the foreground, both in the care of an adult patient with psychiatric disorder and in a group with sheltered children. It is verified how therapists body-apropriation of their patients and how they body-appropriate their sufferings in clinical care, as well as the use of intuitive reflections in dialogue. The results show that a sick body can be humanized in the therapeutic relationship and has possibilities of embodying experiences, thus increasing the affective mobility, of suffering when enjoying oneself. However, if the relationship does not have support and continuity, it is difficult to achieve the stability of this transformation, but leaves marks rooted in each inter-human encounter.
Presentaremos una posible operatividad de la Fenomenología de la Vida de Michel Henry y su método en situaciones clínicas. En este método investigamos el concepto desarrollado por Michel Henry en esta fenomenología denominado cuerpopropriación y la intuición reflexiva en la comprensión e intervención clínica. Es la relación terapéutica en instituciones de salud que es colocada en primer plan, tanto en el cuidado a un paciente adulto con trastorno psiquiátrico como en grupo con niños huérfanos. Se verifica cómo los terapeutas se apropian de sus pacientes y cómo éstos se apropian de sus sufrimientos en los cuidados clínicos, así como el uso de las reflexiones intuitivas en el diálogo. Los resultados nos muestran que un cuerpo enfermo puede ser humanizado en la relación terapéutica y tiene posibilidades de encarnar vivencias, ampliando así la movilidad afectiva, del sufrir al goce de sí. Sin embargo, si la relación no tiene sustentación y continuidad, difícilmente se consigue la estabilidad de esa transformación, pero deja marcas enraizadas en cada encuentro interhumano.
Assuntos
Criança , Criança Acolhida , Psicoterapia InterpessoalRESUMO
El presente trabajo consiste en una revisión de la evidencia que existe hasta la fecha respecto a tratamientos psicosociales y farmacológicos para el trastorno de ánimo bipolar (TAB) en población pediátrica. En cuanto a tratamientos psicosociales destacan: Grupo Psicoeducativo Multifamiliar de Fristad, el Programa Rainbow de Pavuluri, Terapia Focalizada en la Familia para adolescentes, Terapia Interpersonal y de Ritmos Sociales para Adolescentes y la Terapia Dialéctica Comportamental para adolescentes (DBT). Se ha visto que los tratamientos comparten ciertas características, tales como, psicoeducación, establecimiento de hábitos y rutinas, y el trabajo con las familias en términos de desarrollo de habilidades sociales, habilidades de comunicación, afrontamiento al estrés y resolución de conflictos, que serían de relevancia para la mejoría de la sintomatología anímica, la recurrencia de los cuadros anímicos, la adherencia al tratamiento y la prevención de recaídas. Las investigaciones realizadas en intervenciones farmacoterapéuticas muestran que los antipsicóticos atípicos son eficaces en el tratamiento de episodios agudos (maníacos o mixtos), y que podrían ser superiores a los estabilizadores del ánimo en este grupo etáreo. La escasez de estudios en el tratamiento de depresión bipolar y de largo plazo limitan las conclusiones del tratamiento farmacológico en estas fases. Tanto para intervenciones psicosociales como farmacológicas se necesita mayor investigación, ya que existen pocos estudios que aborden el tratamiento del TAB pediátrico, y faltan ensayos controlados aleatorios.
This article is an updated revision of the psychosocial and pharmacological treatments for Pediatric Bipolar Disorder (PBD). Psychosocial treatments include: Fristad Multi-family Psychoeducation Groups, Pavuluri's Rainbow Program, Family Focused Therapy for adolescents, Interpersonal and Social Rhythm Therapy for adolescents and the Dialectical Behavior Therapy for adolescents. These interventions have common characteristics: psychoeducational interventions, habit and routine establishment, social and communication skills training and problem solving skills training. The evidence suggests that these characteristics would help to recover from mood symptoms, delay recurrent episodes, contribute to treatment adherence, and prevent recurrence. Research in pharmacologic interventions shows that atypical antipsychotics are efficacious in treating acute episodes (manic or mixed states), and could be superior to mood stabilizers in this age group. Lack of studies regarding treatment of bipolar depression and long-term treatment limit the conclusions for these pha- ses. Further research is warranted for both psychosocial and pharmacological interventions, specially randomized controlled trials.