Innovative moments with young patients treated for depression: An analysis of post-therapy interviews.

INTRODUCTION: Innovative moments (IMs) pinpoint new and more adaptative meanings that emerge in clients' discourse during psychotherapy. Studies with adult clients have found a greater proportion of IMs in recovered compared to unchanged cases, but similar studies have yet to be conducted with adolescents. AIMS: The paper aims (1) to study retrospectively the emergence of IMs in therapy, using a post-therapy interview, in adolescents that underwent psychotherapy for depression, and (2) to characterize the themes present in IMs identified retrospectively in the interviews. METHOD: Semi-structured post-treatment interviews conducted with 24 adolescents on the experience of taking part in a clinical trial of youth depression, were coded using the Innovative Moments Coding System. After identifying IMs, a thematic analysis identified the prominent themes within them. RESULTS: Higher presence of IMs were found in recovered compared to unchanged cases. Two main themes emerged in the IMs, changes that occurred with therapy and attributions of changes. Recovered cases presented more IMs centred on the self, whereas unchanged cases identified more non-specific changes. CONCLUSION: This study suggests that it is possible to code IMs, identified retrospectively, based on post-therapy interviews with adolescents. Meaningful differences were found between recovered compared to unchanged cases. Therapeutic recovery was associated with a higher focus on the self and more specificity in clients' representations of the change process.

Health Professionals' Explanations of Suicidal Behaviour: Effects of Professional Group, Theoretical Intervention Model, and Patient Suicide Experience.

In a help relation with a suicidal person, the theoretical models of suicidality can be essential to guide the health professional's comprehension of the client/patient. The objectives of this study were to identify health professionals' explanations of suicidal behaviors and to study the effects of professional group, theoretical intervention models, and patient suicide experience in professionals' representations. Two hundred and forty-two health professionals filled out a self-report questionnaire. Exploratory principal components analysis was used. Five explanatory models were identified: psychological suffering, affective cognitive, sociocommunicational, adverse life events, and psychopathological. Results indicated that the psychological suffering and psychopathological models were the most valued by the professionals, while the sociocommunicational was seen as the least likely to explain suicidal behavior. Differences between professional groups were found. We concluded that training and reflection on theoretical models in general and in communicative issues in particular are needed in the education of health professionals.

Genetic counselling supervision: Luxury or necessity? A qualitative study with genetic healthcare professionals in Portugal.

In recent years, there has been a significant technological evolution in the field of genetics, leading to an increase in the number of professionals working in medical genetics and, consequently, a tremendous growth in genetic counselling. At the same time, there has been a growing recognition of the parameters on which to base a safe practice, not only regarding the technical skills of the professional but also regarding their counselling skills, including relational and empathy skills and the acknowledgement of the emotional impact that genetic counselling practice can have. However, despite this growing knowledge, there are still significant differences between the various European countries, and one area where this discrepancy is particularly evident is genetic counselling supervision. Thus, if there are countries where genetic counselling supervision is not even known by the professionals, there are others where it is mandatory for practice. This research had as an objective to understand if and how genetic counselling supervision is provided in Portugal, to identify routines, challenges and impacts of genetic counselling that should be explored in a supervision process and comprehend how professionals believe supervision should be conducted to be effective. A total of sixteen medical geneticists from main Portuguese genetic services were present in two online focus groups. None of the participants had access to genetic counselling supervision as a programmed routine and there was a consensus that a service of this kind would be particularly important for the professionals as genetic counselling has frequently challenging and emotional moments. Aspects regarding clinical supervision, the characteristics of the supervisor and the practical aspects of genetic counselling supervision implementation were also mentioned during the discussions. These results highlight the relevancy of the establishment of GC supervision routines and standardized guidelines in our country, as well as a need for evidence-based research focused on its impact at professional and practice level.

Post-Adoption Help-Seeking in Portugal: A Comprehensive Study on Parental Difficulties and Help-Seeking Behaviors and Perceptions.

Effective psychological parenting interventions delivered to adoptive parents may prevent serious adjustment difficulties and promote a healthy functioning; however, less is known about adoptive parents' specific parental difficulties and help-seeking behaviors and perceptions, the understanding of which is deemed necessary to design well-informed interventions. This study aimed to describe parental difficulties, help-seeking behaviors, satisfaction with, and perceived barriers to seek, professional help, and acceptability of psychological parenting interventions among Portuguese adoptive parents. Comparisons with biological parents (Study 1) and between adoptive parents that requested adoption-specialized and non-specialized support (i.e., adoption-specialized vs. non-specialized help-seekers) (Study 2) were explored. A cross-sectional online survey was conducted. Participants were 471 adoptive and 552 biological parents of children aged under 18 years who were recruited through schools, adoption agencies, and social networks. They completed measures assessing parental difficulties, help-seeking behaviors, satisfaction with, and perceived barriers to seek, professional help, and acceptability of psychological parenting interventions. Comparison tests between the study groups, Pearson's correlations, analyses of covariance (ANCOVA) and multivariate logistic regressions (MLR) were performed. Parents' well-being and normative parenting challenges were the most frequent difficulties in both groups, but only associated with adoptive parents' help-seeking. Although difficulties related to a child's problems/parent-child relationship were more frequent among adoptive parents, adoption-related difficulties were rarely reported. Adoptive parents sought professional help more frequently, regardless of parental difficulties. Knowledge-related barriers to seeking help were the most frequent among adoptive parents. Adoption non-specialized help was less satisfactory. Acceptability of psychological parenting interventions was high, but dependent on parental difficulties. Implications for post-adoption services' development are discussed.

Effects of psychosocial interventions among people cared for in emergency departments after a suicide attempt: a systematic review protocol.

BACKGROUND: The care of the emergency department (ED) for a person after a suicide attempt can act as a protector against future suicidal behavior. For this reason, it is essential that the ED ensure an assistance that involves effective interventions in preventing suicidal behaviors. Among suicidal behaviors, it is known that suicide attempt is one of the most lethal risk factors for consummated suicide. In addition, the risk for further attempts is greater in the period from the immediate post-discharge up to 12 months after the last attempt. This makes the ED a key link in the suicide prevention chain. The purpose of this review is to investigate the effects of psychosocial interventions on suicide prevention, when applied in the ED after a suicide attempt. METHODS: This systematic review protocol was built and registered with the collaboration of a multidisciplinary scientific team. The review will include randomized clinical studies, quasi-experimental trials, and comparative observational studies, all conducted with people (11 years old or more) who have received a psychosocial suicide prevention intervention initiated in the ED after a suicide attempt. The research will be conducted across databases such as Cochrane Library, PubMed, EMBASE, PsycINFO, and DARE. The repetition of a suicide attempt and death by suicide as primary outcomes will be analyzed. The eligibility of the studies and data extraction will be carried out by matched and blind researchers. The risk of bias will be addressed using appropriate instruments. The analyses and synthesis of the results will be both qualitative and quantitative. DISCUSSION: From a public health point of view, suicide is in itself a public health problem and requires appropriate interventions at different levels of care in order to be prevented. Taking into account that a high percentage of people who died by suicide sought the ED for suicide attempt in the year before their death, the ED is a clinical context with a privileged potential to implement these interventions. Presently, several clinical studies seek to validate interventions to be adopted regarding the prevention of suicidal behavior. Current evidence indicates that different interventions must be strategically combined to reduce suicide attempts and their mortality. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42019131040.

Mediators in Psychological Treatments for Anxiety and Depression in Adolescents and Young People: A Protocol of a Systematic Review.

INTRODUCTION: Anxiety and depressive disorders are a significant problem that starts in childhood or adolescence and should be addressed early to avoid chronic mental conditions. There is strong evidence to demonstrate that psychological treatments are effective for these disorders, however, little is known on mediators and mechanisms of change of psychological treatment in adolescents and young adults. Understanding the pathways through which psychological treatments operate will facilitate more effective treatments. AIM: We aim to conduct a systematic review, exploring the available evidence on mediators of psychological treatments for anxiety and depression in adolescents and young adults. METHODS: A systematic search has been performed on PubMed and PsycINFO databases to identify studies from inception to 23rd February 2020. Eligible studies include randomized controlled trials and trials (quasi-experimental) designs that have enrolled adolescents and young adults presenting with depression and/or anxiety and that have examined mediators of psychological treatments. A group of 20 reviewers from the COST-Action TREATme (CA16102) divided into 10 pairs independently screen studies for inclusion, extract information from the included studies, and assess the methodological quality of the included studies and the requirements for mediators. The methodological quality will be assessed by The Mixed Methods Appraisal Tool. Extracted data from the included studies will be collected and presented using a narrative approach. DISCUSSION: This systematic review will summarize and provide a comprehensive overview of the current evidence on mediators of psychological treatments for anxiety and depression for adolescents and young adults. Results will allow the identification of strategies to optimize intervention to enhance clinical outcomes. ETHICS AND DISSEMINATION: Ethics approval is not required. Findings from this systematic review will be published in a peer-reviewed journal and disseminated at conferences and meetings. PROSPERO registration number: CRD42021234641.

Construção e re-construção da identidade nas histórias de vida de adotados / Identity construction and re-construction in life stories of adopted individuals

RESUMO O objetivo deste estudo é identificar como a adoção aparece nas histórias de vida de indivíduos adotados e como eles normalizam suas experiências relacionadas à adoção. Focaliza-se a re-historiação do "eu" na narrativa e considera-se que o seu final é determinado por quem constrói a narrativa, não por eventos relatados cronologicamente. Os dados provêm das narrativas de dois indivíduos adotados, transcritas segundo convenções utilizadas na Análise da Conversa Etnometodológica, nas quais se destaca a presença dos eventos relacionados à adoção na re-historiação dos pesquisados e na constituição de seus "eus" parciais, considerando também as características rítmicas e outras propriedades da fala em interação. Foi possível constatar que o final da história influencia na maneira como a narrativa é construída e como as experiências de adoção aparecem nas narrativas, com maior ou menor grau de normalização a elas atribuído.

ABSTRACT This study aims at identifying how adoption appears in life stories of adopted individuals and how much they normalize their experiences related to adoption. Focus is given to the process of re-historization of the "I", and the end of a narrative is taken as determined by its author instead of the events that are told chronologically. The data comes from narratives of two adopted individuals, transcribed according to Etnomethodological Conversation Analysis. It is pointed out how the events related to adoption appear, when both individuals re-historize their life stories and their partial "I" is constituted. Rhythmical properties and other characteristics of speech are considered in the investigation as well. It was found that the story ending influences on how the narrative is constructed and on how much normalized events related to adoption appear.

Facing a patient who seeks help after a suicide attempt: the difficulties of health professionals.

BACKGROUND: Although intervention with suicidal patients is one of the hardest tasks in clinical practice, little is known about health professionals' perceptions about the difficulties of working with suicidal patients. AIMS: The aims of this study were to: (1) describe the difficulties of professionals facing a suicidal patient; (2) analyze the differences in difficulties according to the sociodemographic and professional characteristics of the health professionals; and (3) identify the health professionals' perceived skills and thoughts on the need for training in suicide. METHOD: A self-report questionnaire developed for this purpose was filled out by 196 health professionals. Exploratory principal components analyses were used. RESULTS: Four factors were found: technical difficulties; emotional difficulties; relational and communicational difficulties; and family-approaching and logistic difficulties. Differences were found between professionals who had or did not have training in suicide, between professional groups, and between the number of patient suicide attempts. Sixty percent of the participants reported a personal need for training and 85% thought it was fundamental to implement training plans targeted at health professionals. CONCLUSION: Specific training is fundamental. Experiential and active methodologies should be used and technical, relational, and emotional questions must be included in the training syllabus.

Patient suicide: the experience of Flemish psychiatrists.

The experience of the most distressing patient suicide on Flemish psychiatrists is described. Of 584 psychiatrists, 107 filled a self-report questionnaire. Ninety-eight psychiatrists had been confronted with at least one patient suicide. Emotional suffering and impotence were the most common feelings reported. Changes in professional practice were described and included a more structured approach to the management of suicidal patients. Colleagues and contact with the patient's family were the most frequently used sources of help, whereas team case review and colleagues were rated as the most useful ones. Patient suicide leads to emotional suffering and has a considerable professional impact.

A construção narrativa da identidade / Narrative construction of identity

Este artigo tem como objetivo apresentar a perspectiva da construção narrativa do self e da identidade a partir da Psicologia Socio-histórica de L. S. Vygotsky,mostrando seu desenvolvimento na Psicologia Cultural, particularmente nos escritos de Jerome Bruner até autores contemporâneos, com destaque para os trabalhos de Hubert Hermans, Dan McAdams, Tilmann Habermas e Robyn Fivush. O conceito de self narrativo aparece como desenvolvimento do paradigma narrativo e como uma importante contribuição ao estudo da internalização das funções psicológicas superiores e à compreensão da construção do sujeito sócio-histórico. A identidade, como espaço de construção do sujeito psicológico parece ser um lócus privilegiado onde podemos observar o funcionamento do paradigma narrativo em termos de negociação de significados entre os acontecimentos biográficos e o indivíduo.

This paper aims to present the narrative construction of the self and the identity from the perspective of Vygotsky's Socio-historical Psychology. It also shows the development of narrative construction in Cultural Psychology, particularly in the writings of Jerome Bruner up to contemporary authors, highlighting the work of Hubert Hermans, Dan McAdams, Tilmann Habermas and Robyn Fivush. The concept of the narrative self appears as a development of the narrative paradigm and as an important contribution to the study of the internalization of higher psychological functions and to the understanding of the construction of the socio-historical subject. The identity as a space for the construction of the psychological subject seems to be a privileged place where we can observe the development of the narrative paradigm in terms of negotiation of meaning between biographical events and the individual.

The role of education in narrative identity construction of young people: focusing on young adoptees / O papel da educação na construção da identidade narrativa em jovens adultos: focando em jovens adotados

During the period of adolescence, the need arises for the individual construct an identity enabler of a productive interplay with the surrounding world. The process of identity construction embeds the development of a sense of unity and purpose that mediates the equilibrium between the society demands for the individual to fit and the individual's psychological well-being. Throughout this process, the formal school education plays a critical role. The current study examines the role school education held in three adopted youths' construction of narrative identity and search for psychological well-being. Life narratives have been utilized in three case studies with young adopted. The narratives were analysed in reference to the Narrative Matrix Analysis System. All three narratives emphasized the school education period as the chronological benchmark that organized and influenced their identity construction and search for support towards belonging and adapting to the society demands.(AU)

A adolescência é o momento em que surge a necessidade de construção de uma identidade que permita à pessoa uma relação produtiva com o mundo. O processo de construção da identidade está relacionado ao desenvolvimento de um sentido de unidade e de propósito diante das demandas da sociedade e ao sentimento de bem-estar. Neste sentido, a educação formal ocupa um lugar de destaque. O presente estudo examina o papel da educação escolar na construção da identidade narrativa em três jovens adultos com história de adoção. Foram utilizadas narrativas de vida em três estudos de caso com os jovens adotados. As narrativas foram submetidas a uma análise baseada no Sistema de Análise da Matriz Narrativa. As três narrativas enfatizam o papel da escola como referência cronológica, que organiza e influencia a construção das identidades, bem como a busca de pertença a um grupo e adequação às demandas sociais.(AU)