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OBJECTIVE: to identify and describe trajectories of change in general psychopathology (p) levels among depressed adolescents who received one of three types of short-term therapies (namely Cognitive-Behavioural Therapy, Short-Term Psychoanalytic Psychotherapy, and a Brief Psychosocial Intervention). METHOD: Participants were 465 adolescents with MDD who participated in an RCT comparing three treatments for depression. Narrow-band measures of depression, anxiety, obsessions-compulsions, and conduct problems were assessed at six-time points, and bifactor analysis was performed to extract p factor scores. These scores were submitted to Latent Class Growth Analyses to identify patterns of change over time. RESULTS: Three different trajectories of change in p were identified. Two trajectories displayed reductions in p across time-points: one a rapid decrease, and the other slower but steady improvement. The third trajectory indicated a limited decrease in p up until the 12th week after baseline but no further improvement at subsequent time-points. Patients' baseline p significantly predicted their outcome trajectories. CONCLUSION: Exploring change in p seemed to describe more parsimoniously the patients' outcomes than the narrow-band assessment of depressive symptoms. Patients with high baseline p were more likely to have poorer outcomes, potentially indicating a need to develop more intensive and tailored treatments for this population.
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Terapia Cognitivo-Conductual , Psicoterapia Breve , Humanos , Adolescente , Trastornos de Ansiedad/terapiaRESUMEN
OBJECTIVE: To identify and describe in-session interaction patterns between psychoanalytic therapists and adolescents diagnosed with major depressive disorder, comparing good and poor outcome cases. METHOD: Audio recordings for 100 psychotherapy sessions from 10 Short-Term Psychoanalytic Psychotherapies were analysed using the Adolescent Psychotherapy Q-Set (APQ). The cases and sessions were evenly divided into two groups (poor outcome and good outcome, 5 patients and 50 sessions per group). Interaction patterns were analysed with an Exploratory Factor Analysis (EFA), while group differences were assessed through t-tests. RESULTS: The EFA revealed three factors: (1) "Open, engaged young person working collaboratively with a therapist to make sense of their experiences", (2) "Directive therapist with a young person fluctuating in emotional state and unwilling to explore", (3) "Young person expressing anger and irritation and challenging the therapist". Factor 1 was significantly more prominent in the good outcome cases, while factor 3, on the contrary, was more significantly related to the poor outcome cases. Factor 2 was equally present in both groups. CONCLUSION: Besides reinforcing to researchers and clinicians the association between a collaborative psychotherapy process with good outcomes, our findings also provide empirical data regarding the role of anger in adolescent depression and the psychotherapy process.
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OBJECTIVE: to examine whether an underlying general psychopathology factor (p factor) existed in children and adolescents attending psychodynamic psychotherapy and whether this general psychopathology factor was associated with family functioning and engagement with psychotherapy. METHOD: Participants were 1976 children and adolescents, and their families, who sought psychodynamic psychotherapy from a community-based clinic in Southern Brazil. The Child Behavior Checklist and the Family Adaptability and Cohesion Evaluation Scales for assessing symptoms and family functioning were used, with treatment engagement data available through linked records. Confirmatory factor analytic methods examined psychopathology and regression models were constructed to examine associations. RESULTS: A general psychopathology factor and specific internalizing and externalizing factors were identified. Higher general psychopathology scores at assessment were associated with an increased likelihood of dropout and poorer attendance compared to completing treatment. Father's educational level, living with both parents, lack of family adaptability and cohesion, and maltreatment experience were related to increased p factor severity. CONCLUSION: General psychopathology severity seems to contribute to child and adolescent psychotherapy outcomes, increasing the risk of non-adherence and dropout. Family difficulties and traumatic experiences may increase p factor severity. Identifying general psychopathology routinely can be crucial for developing effective treatment plans.
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BACKGROUND: In recent years, the prevalence of childhood emotional abuse has surpassed other forms of maltreatment. Childhood verbal abuse (CVA) is a key attribute of emotional abuse, yet CVA is not recognized as its own form of maltreatment and thus, has not received adequate attention. Clear terminology, definitions, and measures are needed to aid in assessing the occurrence and impact of CVA for its recognition and prevention. OBJECTIVE: We aim to synthesize the evidence on the terms, definitions, and measurements of CVA and identify outcomes associated with CVA. PARTICIPANTS AND SETTING: A systematic review focused on adult perpetration of CVA among children and adolescents using clinical, community-based, and population-based samples. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed and four databases were utilized in May 2022: PsycINFO, MEDLINE, EMBASE, and ProQuest. A total of 149 quantitative and 17 qualitative studies were identified. RESULTS: Across studies reviewed, the most common perpetrators of CVA were parents, mothers, and teachers. Definitional themes for CVA included negative speech volume, tone, and speech content, and their immediate impact. The most frequent measures cited were Adverse Childhood Experiences Study (ACE) Questionnaire and the Conflict Tactics Scale (CTS); 50 % used self-created measures. CVA was associated with a range of internalizing and externalizing outcomes across the lifespan. CONCLUSIONS: Recognizing CVA as a form of maltreatment will be a starting point for its identification and prevention. Primary prevention of CVA using trauma-informed approaches must include adult training on the importance of safety, support, and nurturance during verbal communication with children.
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Maltrato a los Niños , Niño , Adulto , Femenino , Adolescente , Humanos , Maltrato a los Niños/psicología , Madres , Encuestas y Cuestionarios , Padres , PrevalenciaRESUMEN
INTRODUCTION: This study developed Brazilian psychodynamic psychotherapy (PDT) and cognitive-behavioral therapy (CBT) prototypes for children with internalizing disorders (ID) and externalizing disorders (ED). METHOD: Eighteen Brazilian experts in PDT (n = 9) and CBT (n = 9) rated the 100 items of the Child Psychotherapy Q-Set (CPQ) describing a hypothetical typical session based on their respective theoretical backgrounds for children with ID. They then rated the same items describing a hypothetical typical session for children with ED. A Q-type factor analysis with varimax rotation was performed. RESULTS: Expert correlations were high within each theoretical approach and each diagnostic category. The factor analysis identified three independent factors. CBT ratings concentrated on one factor, while PDT ratings loaded onto one factor describing treatment of children with ID and another factor describing treatment of children with ED. CONCLUSION: The sole CBT prototype reflected a general conceptualization of this approach and was undifferentiated regarding treatment of children with ID and ED. The PDT prototype for children with ID provided evidence of a process focused on interpretation, while the PDT prototype for children with ED characterized a supportive process with attention to the therapeutic relationship. This infers greater variation in the PDT setting for children with different conditions.
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Terapia Cognitivo-Conductual/métodos , Trastornos Mentales/terapia , Psicoterapia Psicodinámica/métodos , Adolescente , Brasil , Niño , Femenino , Humanos , Masculino , Trastornos Mentales/psicologíaRESUMEN
A mentalização tem sido considerada um elemento importante no processo de mudança na psicoterapia psicodinâmica. No entanto, há uma escassez de instrumentos disponíveis para avaliar o constructo com a população infantil. O Método de Rorschach tem sido sugerido como um procedimento capaz de avaliar a mentalização. Assim, o objetivo deste estudo foi analisar possíveis mudanças no funcionamento psíquico global e na capacidade de mentalização na psicoterapia psicodinâmica de crianças, de acordo com o Método de Rorschach (Sistema Exner). Foi realizado um estudo descritivo e longitudinal baseado no procedimento de Estudo de Caso Sistemático, do qual participaram três crianças em idade escolar. O Método de Rorschach foi aplicado no início e ao final do tratamento. As crianças apresentaram deficit na capacidade de mentalização no início do tratamento, associado a prejuízos no funcionamento psíquico global. Foi possível identificar mudanças na mentalização, ao final da psicoterapia, que se caracterizaram por avanços e retrocessos. O Método de Rorschach provou ser capaz de identificar mudanças na capacidade de mentalização das crianças analisadas.
Mentalization has been considered an important element in the process of change in psychodynamic psychotherapy. However, there is a shortage of available instruments to assess the construct in children. The Rorschach Method has been suggested as a procedure capable of evaluating mentalization. Thus, the aim of this study was to analyze possible changes in the global psychic functioning and in mentalization ability in child psychodynamic psychotherapy, according to the Rorschach Method (Exner System). A descriptive and longitudinal study based on the Systematic Case Study procedure was performed, in which three school-age children took part. The Rorschach Method was applied at the beginning and at the end of the treatment. The children presented impairments in their ability to mentalize at the beginning of the treatment, and it was possible to identify changes in this ability at the end of the psychotherapy. In addition, there was an association between deficits in mentalization and impairments in global psychic functioning. The changes in psychotherapy did not show a steady progress, but were marked by advances and setbacks. The Rorschach Method proved able to detect changes in the mentalization ability of the children.
La mentalización ha sido considerada un elemento importante en el proceso de cambio en la psicoterapia psicodinámica. Sin embargo, hay una escasez de instrumentos disponibles para evaluar el constructo con la población infantil. El método de Rorschach ha sido sugerido como un procedimiento capaz de evaluar la mentalización. Así, el objetivo de este estudio fue analizar posibles cambios en el funcionamiento psíquico global y en la capacidad de mentalización en la psicoterapia psicodinámica de niños, de acuerdo con el Método de Rorschach (Sistema Exner). Se realizó un estudio descriptivo y longitudinal basado en el procedimiento de Estudio de Caso Sistemático, en el que participaron tres niños en edad escolar. El método de Rorschach se aplicó al principio y al final del tratamiento. Los niños presentaron déficit en la capacidad de mentalización al inicio del tratamiento, que estuvieron asociados a pérdidas en el funcionamiento psíquico global. Fue posible identificar cambios en la mentalización, al final de la psicoterapia, que se caracterizaron por avances y retrocesos. El Método de Rorschach demostró ser capaz de identificar cambios en la capacidad de mentalización de los niños analizados.
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Abstract Introduction This study developed Brazilian psychodynamic psychotherapy (PDT) and cognitive-behavioral therapy (CBT) prototypes for children with internalizing disorders (ID) and externalizing disorders (ED). Method Eighteen Brazilian experts in PDT (n = 9) and CBT (n = 9) rated the 100 items of the Child Psychotherapy Q-Set (CPQ) describing a hypothetical typical session based on their respective theoretical backgrounds for children with ID. They then rated the same items describing a hypothetical typical session for children with ED. A Q-type factor analysis with varimax rotation was performed. Results Expert correlations were high within each theoretical approach and each diagnostic category. The factor analysis identified three independent factors. CBT ratings concentrated on one factor, while PDT ratings loaded onto one factor describing treatment of children with ID and another factor describing treatment of children with ED. Conclusion The sole CBT prototype reflected a general conceptualization of this approach and was undifferentiated regarding treatment of children with ID and ED. The PDT prototype for children with ID provided evidence of a process focused on interpretation, while the PDT prototype for children with ED characterized a supportive process with attention to the therapeutic relationship. This infers greater variation in the PDT setting for children with different conditions.
Resumo Introdução Este estudo desenvolveu protótipos brasileiros de psicoterapia psicodinâmica (PP) e terapia cognitivo-comportamental (TCC) para crianças com transtornos internalizantes (TI) e externalizantes (TE). Método Dezoito experts brasileiros em PP (n = 9) e TCC (n = 9) classificaram os 100 itens do Child Psychotherapy Q-Set (CPQ) descrevendo uma sessão hipotética típica de acordo com suas respectivas abordagens teóricas para crianças com TI. Depois, eles classificaram os mesmos itens descrevendo uma sessão hipotética típica para crianças com TE. Foi realizada uma análise fatorial do tipo Q com rotação varimax. Resultados As correlações dos experts foram altas, considerando ambas as abordagens teóricas e as duas categorias diagnósticas. A análise fatorial gerou três fatores independentes. As avaliações da TCC concentraram-se em um fator, enquanto as avaliações da PP geraram um fator que descreveu o tratamento de crianças com TI e um outro fator que descreveu o tratamento de crianças com TE. Conclusão O protótipo único da TCC refletiu uma conceptualização geral dessa abordagem, indiscriminada em relação aos sintomas da criança. O protótipo da PP para crianças com TI evidenciou um processo focado na interpretação, enquanto o protótipo da PP para crianças com TE caracterizou um processo suportivo com atenção à relação terapêutica. Infere-se uma maior variação no processo em PP para crianças com diferentes sintomatologias.
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Humanos , Masculino , Femenino , Niño , Adolescente , Terapia Cognitivo-Conductual/métodos , Psicoterapia Psicodinámica/métodos , Trastornos Mentales/terapia , Brasil , Trastornos Mentales/psicologíaRESUMEN
Esse estudo teve como objetivo comparar o processo da Psicoterapia Psicodinâmica (PP) de uma criança com sintomas internalizantes aos protótipos brasileiros de terapia cognitivo-comportamental (TCC) e de PP para crianças com transtornos internalizantes e externalizantes. Para isso, pares de juízes avaliaram todas as sessões (n=40) da psicoterapia de uma menina com sintomas internalizantes utilizando o Child Psychotherapy Q-Set (CPQ). Os graus de similaridade das sessões aos protótipos brasileiros de psicoterapia foram calculados via correlação de Pearson. Como resultado, o tratamento apresentou similaridade significativa simultaneamente aos protótipos da TCC e da PP para crianças com transtornos internalizantes. Não foi encontrada similaridade significativa ao protótipo da PP para crianças com transtornos externalizantes. Verificou-se que os protótipos brasileiros de psicoterapia de crianças mostraram-se uma ferramenta útil na avaliação desse processo terapêutico. Os dados apresentados indicam que, na prática, as características das psicoterapias de crianças se sobrepõem e os processos apresentam um caráter integrativo.
This study aimed to compare the psychodynamic psychotherapy (PDT) process of a child with internalising symptoms to Brazilian prototypes of Cognitive-behavioural therapy (CBT) and PDT for children with internalizing and externalizing disorders. For that purpose, pairs of judges rated all PDT sessions (n=40) of a girl with internalising symptoms using the Child Psychotherapy Q-Set (CPQ). The degrees of similarity to the Brazilian prototypes were assessed via Pearson correlation. The results indicated that the treatment presented simultaneous significant similarity to the prototypes of CBT and PDT for children with internalising disorders. The similarity to the prototype of PDT for children with externalising disorders was not significant in this treatment. The findings suggest that the Brazilian prototypes of child psychotherapy were a useful assessment tool for this psychotherapeutic process. The data presented indicate that, on clinical practice, psychotherapies features overlap, and child psychotherapy processes have an integrative nature.
Este estudio tuvo por objetivo comparar el proceso de la psicoterapia psicodinámica (PP) de una niña con síntomas internalizantes con prototipos brasileños de terapia cognitiva-conductual (TCC) y PP para niños con trastornos internalizantes y externalizantes. Para eso, pares de jueces calificaron todas las sesiones de la PP (n=40) de una niña con síntomas internalizantes utilizando el Child Psychotherapy Q-Set (CPQ). Los grados de similitud con los prototipos brasileños se evaluaron mediante la correlación de Pearson. Como resultado, el tratamiento presentó una similitud significativa simultánea con los prototipos de TCC y PP para niños con trastornos internalizantes. La similitud con el prototipo de la PP para niños con trastornos externalizantes no fue significativa en este tratamiento. Los prototipos brasileños de psicoterapia infantil demostraron ser una herramienta útil para la evaluación de este proceso psicoterápico. Los datos presentados indican que, en la práctica clínica, las psicoterapias se superponen, y los procesos de psicoterapia infantil tienen una naturaleza integradora.
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Psicología Clínica , Terapia Cognitivo-Conductual , Psicología InfantilRESUMEN
OBJETIVO: Descrever o perfil sociodemográfico e clínico dos bebês de zero a 36 meses que foram levados por seus pais ou responsáveis para psicoterapia em uma clínica-escola em saúde mental de Porto Alegre. MÉTODO: Realizou-se um estudo documental de revisão de prontuários dos pacientes atendidos entre maio de 2009 a maio de 2016. Os responsáveis pelos pacientes que chegaram à instituição nesse período responderam uma ficha sociodemográfica, abarcando dados sobre a criança e seu contexto, e o Child Behavior Checklist (CBCL), versão de 1½ a 5 anos de idade. Incluíram-se no estudo todos os bebês triados na clínica-escola e suas respectivas famílias (n=25). RESULTADOS: Grande parte dos pacientes cujas famílias procuraram atendimento já tinham completado 2 anos de idade (92%), e pouco mais da metade desses bebês residiam com ambos os pais (52%). Profissionais da área da saúde foram a principal fonte de encaminhamento (44%), seguidos das famílias dos bebês (28%) e das escolas que frequentam (24%). Os motivos de busca para atendimento mais encontrados foram comportamento agressivo (36%), problemas de atenção (20%) e ansiedade/depressão (16%). A partir dos resultados do CBCL, identificou-se que 48% dos bebês apresentaram escore clínico em sua média total, 44% apresentaram escore clínico para problemas internalizantes e 36% para problemas externalizantes. CONCLUSÃO: Ressalta-se a necessidade de popularizar os conhecimentos acerca da saúde mental dos bebês.(AU)
OBJECTIVE: To describe the demographic and clinical profile of babies from zero to 36 months old assisted in a mental health school-clinic in Porto Alegre. METHOD: A documentary research with the clinical records of patients, assisted from May 2009 to May 2016, was performed. Those responsible for the children, who sought the institution during this period, answered a demographic form, covering aspects of the child and its context, as well as the Child Behavior Checklist 1.5-5 (CBCL/1.5-5). All the babies screened in the school-clinic and their respective families (n=25) were included in this study. RESULTS: A great quantity of patients whose families sought treatment were already two years old (92%), and more than half of them lived with both their parents (52%). Health professionals were the main referral source (44%), followed by the babies' families (28%) and the schools they attended (24%). The most common reported complaints were regarding aggressive behavior (36%), attention problems (20%) and anxiety/depression (16%). According to the CBCL results, it was identified that 48% of the babies presented a clinical score for Total Problems, while 44% had clinical ratings for internalizing problems and 36% had clinical ratings for externalizing problems. CONCLUSION: The need to highlight and popularize the knowledge on babies' mental health.(AU)
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Pacientes Ambulatorios , Psicoterapia Psicodinámica , Signos y SíntomasRESUMEN
Este estudo objetivou investigar o perfil de casais e famílias que procuram atendimento em psicoterapia psicanalítica, através de pesquisa quantitativa retrospectiva com prontuários de pacientes ambulatoriais de Porto Alegre/RS. Na terapia de casais, a maior parte dos pacientes buscou tratamento por iniciativa própria, alegando dificuldades de comunicação. Na psicoterapia familiar, houve predomínio de famílias monoparentais, constituídas por mãe + filho(s); a maioria buscou psicoterapia recomendada por psicólogo, sendo o motivo de consulta predominante a busca de orientação quanto ao manejo com os filhos. A estrutura familiar inconsciente neurótica foi o diagnóstico mais prevalente e a renda familiar predominante oscilou de 2 a 6 salários mínimos, tanto para casais quanto para famílias. A maior parte dos casais e famílias não aderiu à psicoterapia. Espera-se que estes dados auxiliem na capacitação dos profissionais, no desenvolvimento de novos ambulatórios e na divulgação dessa modalidade de atendimento, atraindo a população que ainda se encontra desassistida.(AU)
This study aimed to investigate the profile of couples and families seeking care in psychoanalytic psychotherapy through retrospective quantitative research with outpatient records in Porto Alegre/Brazil. In couples' therapy, most patients sought treatment on their own initiative, claiming difficulties in communication. In family psychotherapy, there was a predominance of single-parent families consisting of mother + child/children; most sought psychotherapy referred by a psychologist, seeking guidance for dealing with their children. Neurotic unconscious family structure was the diagnosis that obtained the highest index and the most prevalent family income ranged from 2 to 6 Brazilian minimum wages for both couple and family psychotherapy. Most couples and families who sought treatment did not adhere to psychotherapy. It is hoped that these data will help to train more competent professionals, to develop new clinics, and to propagate this type of service, attracting the population that is still unassisted.(AU)
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Relaciones Familiares , Terapia Familiar , Terapia Conyugal , Pacientes Ambulatorios , Terapia PsicoanalíticaRESUMEN
Este estudo teve como foco a aliança terapêutica na psicoterapia de crianças. A literatura vem apontando a importância da aliança terapêutica no processo psicoterápico, considerando-a um elemento fundamental para o sucesso do tratamento. Foi realizada uma revisão sistemática da literatura, com o objetivo de identificar e analisar estudos sobre a temática. Foram identificados 26 estudos que contemplaram os critérios de inclusão. A revisão revelou um aumento significativo das pesquisas com este foco, na última década, revelando características do paciente, do terapeuta e da família que possuem relação com a qualidade da aliança estabelecida entre terapeuta e paciente. Evidenciou-se, também, a forte associação da aliança terapêutica aos resultados efetivos dos tratamentos. Salienta-se a necessidade de uma melhor conceitualização do fenômeno para a população infantil, como também sua integração com instrumentos que mensurem a aliança terapêutica em toda sua complexidade.
The present study focused on the alliance therapeutic in child psychotherapy. The literature emphasizes the importance of the therapeutic alliance in psychotherapy process, considering it a fundamental element for the success of treatment. This study systematically reviewed the research literature with aim to identify and analyze studies about this research focus. It was identified 26 separate studies that met criteria for inclusion. The review revealed a significant increase in research with this focus in the last decade, revealing characteristics of the patient, the therapist and the family that are related to the quality of the alliance between therapist and patient. It was also evidenced the strong association of the therapeutic alliance to effective treatment outcomes. We emphasize the need for better conceptualization of the phenomenon for the children, as well as its integration with instruments that measure the therapeutic alliances complexity.
Este estudio se centró en la alianza terapéutica en la psicoterapia de niños. La literatura que apunta a la importancia de la alianza terapéutica en el proceso de la psicoterapia, teniendo en cuenta que un elemento fundamental para el éxito del tratamiento. Una revisión sistemática de la literatura, con el objetivo de identificar y analizar los estudios sobre el tema se llevó a cabo. Se identificaron 26 estudios que contemplan los criterios de inclusión. El examen reveló un aumento significativo en la investigación con este enfoque en la última década, revelando características del paciente, el terapeuta y la familia que están relacionados con la calidad de la alianza entre el terapeuta y el paciente. Además, se reveló la fuerte asociación de la alianza terapéutica con los resultados efectivos de tratamiento. Hacemos hincapié en la necesidad de una mejor conceptualización del fenómeno para la población pediátrica, así como su integración con instrumentos que miden la alianza terapéutica en toda su complejidad.