Is the quality of therapeutic collaboration associated with the assimilation of problematic experiences progress? A comparison of two cases.

OBJECTIVE: How are collaborative interactions associated with clients' progress in therapy? This study addressed this question, by assessing the quality of therapeutic collaboration and comparing it passage by passage with the clients' assimilation of problematic experiences in two cases of major depression treated with Cognitive Behavioral Therapy, one recovered and one improved-but-not-recovered. METHOD: We used the Therapeutic Collaboration Coding System to code collaborative work and the Assimilation of Problematic Experiences Scale (APES) to rate clients' progress. In both cases, for the distribution of specific collaborative therapeutic exchanges, we tested for the difference of empirical means between lower and higher APES levels. RESULTS: Both cases progress in APES, but in contrast with Annie (Improved-but-not-recovered), Kate (Recovered) achieved higher levels of change in last sessions. In addition, we found significant differences in the types of collaborative therapeutic exchanges associated with lower and higher APES levels. CONCLUSION: Ambivalent therapeutic exchanges distinguished the recovered case from the not recovered case highlighting a source of difficulties in facilitating therapeutic change in CBT. In addition, observations in these cases supported the theoretical suggestion that supporting interventions would be better accepted at lower APES levels, whereas challenging interventions would be better accepted at higher APES levels.

The association between reflective function and global functionality in patients with borderline personality disorder.

OBJECTIVE: To examine the association between reflective function and global functionality in borderline personality disorder (BPD) patients, controlling for symptomatology and defensive style. METHOD: Thirty-nine female inpatients were evaluated employing a sociodemographic questionnaire, the Structured Clinical Interview for Personality Disorders-II (SCID-II), the Self-Reporting Questionnaire (SRQ-20), the Reflective Functioning Questionnaire (RFQ), the Defence Style Questionnaire-40 (DSQ-40) and the Global Assessment of Functioning (GAF). RESULTS: Functionality was inversely associated with the reflective function uncertainty score (-.458; p < .01) and neurotic defences (-.335; p < .05). Symptom severity (SRQ-20) was associated with the use of immature defences (-.445; p < .01). The association between functionality and the reflective function uncertainty score remained significant, even when controlled for symptoms and defensive style (p = .002). CONCLUSION: The ability to mentalise seems to play a central and somehow independent role in BPD psychopathology.

Handling suicidal crises in psychodynamic psychotherapy: A process case study.

The core characteristics of patients with a borderline personality disorder (BPD) affect the therapeutic relationship and frequently lead psychodynamic therapists to adapt interventions to manage crises. This study aims to increase knowledge of how such crises affect the therapeutic process. Using her therapist's notes, combined with the Psychotherapy Process Q-Set, we studied the therapeutic process of the first 44 therapy sessions of a female BPD patient with many depressive-like symptoms, including a disruptive period that included hospitalization. We found marked differences between different phases of therapy (before a crisis, acute disorganization, hospitalization, and back to the consulting room). The analysis suggests that a crisis and hospitalization may occur without necessarily damaging the therapeutic process. The therapist's ability to tolerate aggression, to explore and contain suicide wishes and behaviors, and to flexibly adapt techniques to patient needs, are among the therapeutic attitudes and behaviors that can help restore an effective psychodynamic process.

Longitudinal Distress among Brazilian University Workers during Pandemics.

The present study aimed to examine changes in mental distress in Brazilian university workers during the pandemic. All workers (n ≃ 1850) of an institution were invited to respond to a survey that took place in three stages, with collections in May (n = 407), June/July (n = 258), and August (n = 207) 2020, and included questions on demographic, health, general and psychological support, and psychometric assessment of mental distress (Clinical Outcome Routine Evaluation- CORE-OM) combined with an open question about major concerns. The results of the Multilevel Modeling analysis pointed to the absence of significant differences across the repeated measures of distress. The only variable associated with increased psychological distress over time was a lower level of support for household chores. Qualitative analysis of the reported major concerns was carried out with a sub-sample who showed reliable deterioration in CORE-OM across time (n = 17). The diversity of concerns reported by this group reinforced that work-life imbalance contributes to mental distress of university workers during the pandemic. Low response rate, although not unexpected due to the circumstances, limits the generalization of findings. The present data suggest that in addition to issues related to contagion and specific restricted measures to contain the spread of the disease, the personal reorganization of life required to maintain activities at home and work can be an important contributor to pandemic-related psychological distress.

Relationship between childhood trauma, parental bonding, and defensive styles and psychiatric symptoms in adult life.

INTRODUCTION: A relationship between different types of childhood trauma, parental care, and defensive styles and development of psychiatric symptoms in adulthood is proposed in this study. Understanding the nature of this association is essential to assist psychotherapists who treat patients with a history of past trauma. This study aims to examine the associations between childhood trauma, parental bonding, and defensive styles and current symptoms in adult patients who sought care at an analytical psychotherapy clinic. METHODS: The sample comprised 197 patients from an analytically oriented psychotherapy clinic. Participants responded to four self-report instruments that assessed, respectively, presence and frequency of several types of early trauma, type of parental attachment, styles of defenses, and current symptoms encompassing a wide variety of psychopathological syndromes. RESULTS: Only 5% of patients reported not having experienced any traumatic experience in childhood. Several traumas such as emotional and physical abuse, emotional neglect, and physical neglect showed positive and significant associations with several dimensions of current symptoms, and also with parental bonding and defensive styles. When analyzed together with the other variables, defensive styles explained the level of psychological suffering caused by the symptoms. CONCLUSIONS: This study offers additional support for understanding the associations between childhood trauma, parental bonding styles, and defense styles and the psychiatric symptoms of patients in analytically oriented psychotherapy.

The process of change in brief psychotherapy: effects of psychodynamic and cognitive-behavioral prototypes.

A brief psychodynamic psychotherapy was assessed using the Brazilian Portuguese version of the Psychotherapy Process Q-Set (PQS). Each session was scored for its adherence to expert psychodynamic therapy (PDT) and cognitive-behavioral therapy (CBT) prototypes derived from the PQS. Results revealed that the therapy process adhered more closely to prototypical CBT than prototypical PDT. Bivariate time-series analyses showed that prototype components capturing the client's adherence to ideal CBT behaviors and collaboration between therapist and client on ideal PDT and CBT behaviors predicted therapy progress. In addition, specific client symptoms influenced whether the therapist adhered to prototypical PDT or CBT behaviors.

Psychological Distress of University Workers during COVID-19 Pandemic in Brazil.

The study aimed to explore mental distress during COVID-19 quarantine in a sample of university workers in Brazil. The survey included sets of questions about demographics, health, and support, an open question about major concerns, and the Clinical Outcome Routine Evaluation (CORE-OM), a measure of mental distress. A total of 407 professionals, mean age 40, SD 11.2, fulfilling social distancing (99%) participated in the study. Participants were mostly female (67.8%) and married (64.8%). Using the Consensual Qualitative Research process for simple qualitative data (CQR-M), the main areas of concern were grouped into six domains, as follows: work, health, isolation, personal life and routine, social environment, and future. Many responses were multiple. They form categories indicating specific concerns within these domains. Quantitative data were analyzed by identifying the simple effects of potential predictors of mental distress. The results indicated medium effects of help with household chores (η2 = 0.06, 95% confidence interval (CI) (0.022-0.095)), psychiatric treatment (η2 = 0.06, CI (0.030-0.110)), age (η2 = 0.12, CI (0.070-0.170)), and physical exercise (η2 = 0.12, CI (0.079-0.180)). Having someone available to listen was the only variable with a large effect associated with reduced mental suffering (η2 = 0.18; CI (0.118-0.227)). Psychological experiences of the pandemic are multifaceted and complex. Thus, substantially larger surveys, with both quantitative and qualitative components, are needed.

The Brazilian-adapted Working Alliance Inventory: preliminary report on the psychometric properties of the original and short revised versions.

INTRODUCTION: Alliance is an essential component of all psychotherapies and a consistent predictor of its outcomes. The Working Alliance Inventory (WAI) is a widely used and psychometrically sound measure of alliance. It assesses three key aspects of the construct: a) agreement on the tasks of therapy; b) agreement on the therapeutic goals; and c) development of an affective bond. OBJECTIVE: To preliminarily analyze the psychometric properties of the Brazilian version of both the original, 36-item WAI, and of the short form revised, 16-item version (WAI-SR). METHODS: The sample comprised 201 psychodynamic psychotherapy patients. Alliance assessments were made after the 4th treatment session. RESULTS: The inventory adapted to Brazilian Portuguese, in both the original and short forms, appears to be reliable and valid to measure alliance and its dimensions by clients in psychotherapy. Further studies are needed to replicate and expand the findings.

Translation and cultural adaptation of the DSM-5 Personality Inventory - Brief Form (PID-5-BF).

INTRODUCTION: The Personality Inventory for the DSM-5 - Brief Form (PID-5-BF) - is an instrument for assessment of the five pathological personality traits from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) alternative model of personality disorders. OBJECTIVES: To determine the psychometric properties of the version of the PID-5-BF translated and adapted to Brazilian Portuguese. METHODS: The process of translating and cross-culturally adapting the text was carried out by independent translators and the resulting version was administered to 176 patients in two hospitals in Rio Grande do Sul. The internal structure was tested by means of confirmatory factor analysis. Evidence of reliability was tested by examining the internal consistency of the scales and their convergent and concurrent validity with other methods of psychopathology. RESULTS: The five factors were replicated in the present sample with adequate indicators of fit of the data to the model. Appropriate reliability coefficients for the scales and evidence of validity were observed, indicating the clinical usefulness of the PID-5-BF in the Brazilian context. CONCLUSION: The psychometric properties of PID-5-BF proved satisfactory in an initial sample of Brazilians.

Interaction structures in the psychodynamic psychotherapy of a patient with chronic diseases and somatic symptoms.

OBJECTIVE: This study aimed to identify and analyze the interaction structures (ISs) (patterns of reciprocal interaction between the patient-therapist dyad) that characterize the process of a successful long-term psychodynamic psychotherapy (28 months) of a patient with chronic diseases (lupus and fibromyalgia) and somatic symptoms. METHODS: The 113 sessions were videotaped and analyzed alternately (n = 60) by independent judges using the Psychotherapy Process Q-Set. Inter-rater reliability ranged from 0.60 to 0.90, with a mean of r = 0.71 (Pearson's correlation). Through a principal component exploratory factor analysis, four ISs were identified. RESULT: The patterns of interaction between patient and therapist showed clinical validity (i.e., they were easily interpretable in the context of the case under study). The ISs were non-linear and more or less prominent across different treatment sessions and stages. Some ISs were similar to those in other studies, and others were probably unique to the present process. In addition, some ISs were independent, whereas others were interrelated over time. CONCLUSION: Process studies, such as the present one, seek to address questions about the characteristics of the interaction between patient and therapist as well as to identify particular patterns of interaction that are most prominent with a specific patient at a specific condition or time. Therefore, these studies can provide some support in establishing knowledge for clinical practice, assisting in the training of therapists, as well as in the elaboration of general guidelines for the technical management of patients with specific characteristics.

Mudança nos Conflitos Interpessoais de uma Paciente Borderline em Psicoterapia Psicodinâmica / Modificación de los conflictos interpersonales de un paciente límite en psicoterapia psicodinámica / Change in Interpersonal Conflicts of a Borderline Patient in Psychodynamic Psychotherapy

Pacientes com Transtorno de personalidade borderline(TPB) possuem características relacio-nais disfuncionais que impactam seus relacionamentos interpessoais. O objetivo foi o de des-crever os padrões relacionais de conflito de uma paciente com TPB da psicoterapia psicodinâ-mica. Trata-se de um estudo de caso sistemático. Utilizou-se o método Tema Central de Confli-to nos Relacionamentos (CCRT). Juízes independentes analisaram as gravações e transcrições das sessões do tratamento. A análise foi realizada com base na frequência dos componentes do CCRT. Os resultados indicam que o conflito central da paciente se mantém o mesmo ao longo do tempo, assim como seu desejo principal, mas háuma mudança significativa nas respostas, ou seja, na forma como a paciente interage em seus relacionamentos, apresentando maior fle-xibilidade para lidar com os outros e os percebendo mais positivamente. O estudo fornece sub-sídios aos psicoterapeutas para identificar e trabalhar o padrão de relacionamento disfuncional de pacientes com TPB. (AU)

Patients with borderline personality disorder (BPD) have dysfunctional relational characteris-tics that impact their interpersonal relationships. The aim of this study was to describe the conflicting relational patterns of a BPD patient of psychodynamic psychotherapy. This is a sys-tematic case study. Core Conflictual Relationship Theme —CCRT method was used to identify in relationship episodes the components of the central conflict. Independent judges reviewed the recordings and transcripts of the initial sessions of treatment and the final sessions of each year of treatment. The analysis was performed based on the frequency of CCRT compo-nents. The results indicate that the patient’s core conflict remains thesame over time, as does her core desire, but there is a significant change in the way the patient interacts in her relationships. As a clinical contribution, the study provides support to psychotherapists to identify and work on the central pattern of dysfunctional relationships of patients with BPD. (AU)

Estruturas de interação no tratamento psicodinâmico de uma paciente com Transtorno de Personalidade Borderline / Estructuras de interacción en el tratamiento psicodinámico de un paciente con Trastorno Límite de la Personalidad / Interaction Structures in the Psychodynamic Therapy of a Patient with Borderline Personality Disorder

Estruturas de interação são padrões repetitivos que ocorrem entre terapeuta e paciente, mesmo que am-bos não sejam conscientes disso. Na pesquisa empíri-ca, elas ajudam a compreender como se estabelece o processo de mudança em psicoterapia. Nesse sentido, esta investigação utilizou 68 sessões de psicoterapia psicanalítica de um caso de uma jovem paciente com Transtorno de Personalidade Borderline (tpb) com o objetivo de identificar as estruturas de interação e sua correlação com o tempo de tratamento. Os dados fo-ram gravados em vídeo e posteriormente codificados através do Psychotherapy Process Q-Set (pqs), por duplas de juízes treinados na metodologia Q-Sort. A partir desses dados, foi realizada a análise fatorial do tipo Q de componentes principais que indicou quatro estruturas de interação, sendo fator 1: Colaborativo; fa-tor 2: Resistência; fator 3: Aliança/Ruptura e fator 4: Apoio/Encorajamento. As estruturas indicaram que a interação se voltou para o trabalho de manutenção da interação colaborativa, através de uma posição empá-tica do terapeuta, direcionado para o reconhecimento dos estados internos do paciente. Apesar do trabalho colaborativo, a resistência também surgiu como um padrão repetitivo. O terapeuta se tornou diretivo com intervenções estruturadas e questionando o paciente, desta forma contribuindo para o desenvolvimento da capacidade de mentalização. Implicações sobre o pro-cesso psicoterápico e indicações para estudos futuros são apresentados com o intuito de contribuir na com-preensão sobre o tratamento de pacientes com tpb em psicoterapia psicodinâmica.

Las estructuras de interacción son patrones repetitivos que ocurren entre el terapeuta y el paciente, incluso si ambos no son conscientes de esto. En la investigación empírica ayudan a comprender cómo se establece el proceso de cambio en psicoterapia. En tal sentido, esta investigación utilizó 68 sesiones de psicoterapia psicoanalítica del caso de un paciente joven con Tras-torno Límite de la Personalidad (tlp) para identificar las estructuras de interacción y su correlación con el momento del tratamiento. Los datos fueron grabados en video y posteriormente codificados utilizando el Q-Set Proceso de Psicoterapia (pqs), por pares de jueces en-trenados en la metodología Q-Sort. Con base en estos datos, se realizó un análisis factorial del tipo Q de componentes principales, el cual indicó cuatro estructuras de interacción, siendo factor 1: Colaborativo; factor 2: Resistencia; factor 3: Alianza/Disrupción y factor 4: Apoyo/Estímulo. Las estructuras indicaron que la interacción se tornó al trabajo de mantener la interacción colaborativa, a través de una posición empática del terapeuta, dirigida al reconocimiento de los estados internos del paciente. A pesar del trabajo colaborativo, la resistencia también surgió como un patrón repetitivo. El terapeuta se volvió directivo con intervenciones estructuradas cuestionando al paciente, contribuyendo así al desarrollo de la capacidad mentalizadora. Se presentan implicaciones en el proceso psicoterapéutico e indicaciones para futuros estudios con el objetivo de contribuir a la comprensión del tratamiento de pacientes con tlp en psicoterapia psicodinámica.

Interaction structures are repetitive patterns of interaction between therapist and patient, even if they are not conscious of it. In empirical research, they help to un-derstand how the process of change in psychotherapy is established. In this sense, the current research used 68 sessions of psychoanalytic psychotherapy in a young patient with Borderline Personality Disorder (bpd) to identify the interaction structures and their correlation with different moments of treatment. The sessions were recorded on video and later encoded through the Psy-chotherapy Process Q-Set (PQS) by pairs of judges trained in Q-Sort methodology. A factor analysis of the Q-type of main components was performed based on these data, which indicated four interaction structures. Factor 1: Collaborative; factor 2: Resistance; factor 3: Alliance/Rupture; and factor 4: Support/Encornment. The structures indicated the interaction became a work of maintenance of the collaborative interaction through an empathic position of the therapist, focused on recognizing the patient's internal states. Despite the collaborative work, resistance also appeared as a repetitive pattern. The therapist became more directive with more structured interventions questioning the patient, thus, contributing to the development of the capacity of mentalization. Implications for the psychotherapeutic process and in-dications for future studies are presented to contribute to the comprehension of the treatment of patients with bpd in psychodynamic psychotherapy.

Relações de apego e Transtorno de Déficit de Atenção com Hiperatividade infantil / Attachment relationships and child Attention Deficit Hyperactivity Disorder

A insuficiência de condições seguras de apego pode estar associada a dificuldades no desenvolvimento infantil e vulnerabilidade para o surgimento de condições clínicas diversas, como o Transtorno do Déficit de Atenção com Hiperatividade (TDAH). Foi realizada uma revisão narrativa da literatura buscando contribuições da Teoria do Apego para a compreensão de fatores ambientais associados ao TDAH infantil. A revisão incluiu artigos teóricos e empíricos dos Portais do Index Psi, PubMed, Capes e Google acadêmico publicados nos idiomas português, inglês e espanhol entre 2002 a 2021. Os estudos apontaram que: crianças com TDAH apresentam em geral as mesmas dificuldades no desenvolvimento das que possuem apego primário inseguro; o apego de crianças com TDAH difere das crianças típicas, sendo predominantemente inseguro; estudos com pais dessas crianças têm encontrado dificuldades na função reflexiva destes. Conclui-se que o laço estabelecido entre criança e cuidador principal pode ser considerado um fator de proteção ou risco para o desenvolvimento infantil. A Teoria do Apego pode oferecer suporte para pensar diferentes fatores ambientais associados ao TDAH.(AU)

The insufficiency of secure attachment conditions may be associated with difficulties in child development and vulnerability to the onset of various clinical conditions, such as Attention Deficit Hyperactivity Disorder (ADHD). A narrative literature review was carried out seeking contributions from Attachment Theory to the understanding of environmental factors associated with childhood ADHD. Revision included theoretical and empirical articles from Index Psi, PubMed, Capes and Scholar Google published in Portuguese, English and Spanish between 2002 and 2021. The studies showed that: children with ADHD generally have the same difficulties in development of those with primary insecure attachment; the attachment of children with ADHD differs from typical children, being predominantly insecure; studies with parents of these children have found difficulties in their reflective function. It is concluded that the bond established between the child and the main caregiver can be considered a protective or risk factor for child development. Attachment Theory can support thinking about different environmental factors associated with ADHD.(AU)

La insuficiencia de las condiciones de apego seguro puede se asociar con dificultades en el desarrollo infantil y vulnerabilidad a la aparición de diversas condiciones clínicas, como el trastorno por déficit de atención con hiperactividad (TDAH). Se llevó a cabo una revisión de la literatura narrativa buscando contribuciones de la Teoría del Apego a la comprensión de los factores ambientales asociados con el TDAH infantil. La revisión incluyó artículos teóricos y empíricos de los portales Index Psi, PubMed, Capes y Academic Google publicados en portugués, inglés y español entre 2002 y 2021. Los estudios mostraron que: los niños con TDAH generalmente tienen las mismas dificultades de desarrollo que aquellos con inseguridad apego primario; el apego de los niños con TDAH difiere del de los niños típicos, ya que es predominantemente inseguro; Los estudios con padres de estos niños han encontrado dificultades en su función reflexiva. Se concluye que el vínculo que se establece entre el niño y el cuidador principal puede considerarse un factor protector o de riesgo para el desarrollo infantil. La Teoría del Apego puede apoyar el pensamiento sobre diferentes factores ambientales asociados con el TDAH.

Reações contratransferenciais de psicoterapeutas frente a uma paciente borderline em psicoterapia: um estudo qualitativo / Countertransferential reactions of psychotherapists towards a borderline patient in psychotherapy: a qualitative study

A contratransferência (CT) é um elemento do relacionamento terapêutico que possui valor clínico, especialmente com pacientes com personalidade borderline (PB). Este estudo, qualitativo e exploratório, visou identificar os sentimentos despertados em psicoterapeutas frente a um caso de paciente com PB, buscando compreendê-los em relação às características da paciente ou da sua narrativa, bem como explorar de que forma a CT seria idealmente manejada. Oito psicoterapeutas assistiram ao vídeo de uma sessão real com paciente com PB e, após, responderam a uma entrevista. As transcrições das entrevistas foram analisadas com o método Consensual Qualitative Research (CQR). Os dados organizaram-se em relação às facetas da CT, características da paciente que mobilizam afetos, e manejo da CT. Os resultados sugerem que pacientes com PB tendem a suscitar sentimentos intensos, vinculados a sua história e seu funcionamento em situação observacional, apontando para a viabilidade do método para o estudo empírico da CT. Resultados de estudos como esse podem ser utilizados como guia para jovens terapeutas compreenderem o mundo interno dos seus pacientes. A validação empírica de hipóteses clínicas fortalece a teorização e enriquece a prática psicanalítica.(AU)

Countertransference (CT) is an element of the therapeutic relationship that has clinical value, especially with borderline personality patients (BP). This qualitative and exploratory study aimed to identify the feelings aroused in psychotherapists in the case of a BP patient, seeking to understand them in relation to the patient's characteristics or her narrative, as well as exploring how the CT would be ideally managed. Eight psychotherapists watched the video of a real session with a BP patient and responded to an interview. The interview transcripts were analyzed using the Consensual Qualitative Research (CQR) method. The data were organized in relation to the facets of the CT, characteristics of the patient that mobilize affections, and management of the CT. The results suggest that patients with BP tend to elicit intense feelings, linked to their history and functioning, in an observational situation, pointing to the feasibility of the method for the empirical study of CT. Results from studies like this one can be used as a guide for young therapists to understand the inner world of their patients. Empirical validation of clinical hypotheses strengthens theorization and enriches psychoanalytic practice.(AU)

La contratransferencia (CT) es un elemento de la relación terapéutica que tiene valor clínico, especialmente en pacientes con personalidad límite (BP). Este estudio cualitativo y exploratorio tuvo como objetivo identificar los sentimientos que despiertan los psicoterapeutas en el caso de un paciente con BP, buscando comprenderlos en relación con las características de la paciente o su narrativa, así como explorar cómo se manejaría idealmente la CT. Ocho psicoterapeutas vieron el video de una sesión real y luego respondieron a una entrevista. Las transcripciones de las entrevistas se analizaron utilizando el método de Investigación Cualitativa Consensual (CQR). Los datos se organizaron en relación a las facetas del CT, características del paciente que movilizan afectos y manejo de la CT. Los resultados sugieren que los pacientes con BP tienden a provocar sentimientos intensos, ligados a su historia y funcionamiento, en una situación de observación, lo que apunta a la viabilidad del método para el estudio empírico de la CT. Los resultados de estudios como este pueden usarse como una guía para que los terapeutas jóvenes comprendan el mundo interior de sus pacientes. La validación empírica de hipótesis clínicas fortalece la teorización y enriquece la práctica psicoanalítica.(AU)

Development of Brazilian prototypes for short-term psychotherapies.

INTRODUCTION: The Psychotherapy Process Q-Set (PQS) prototype method is used to measure the extent to which ideal processes of different psychotherapies are present in real cases, allowing researchers to examine how adherence to these models relates to or predicts change. Results from studies of short-term psychotherapies suggest that the original psychodynamic prototype is more suitable for studying psychoanalysis and long-term psychodynamic psychotherapy than its time-limited counterparts. Furthermore, culture probably influences how therapies are typically conducted in a given country. Therefore, it seems appropriate to develop Brazilian prototypes on which to base studies of short-term psychodynamic and cognitive-behavioral processes in this country. OBJECTIVE: To develop prototypes for studying processes of short-term psychotherapies and to examine the degree of adherence of two real psychotherapy cases to these models. METHODS: Expert clinicians used the PQS to rate a hypothetical ideal session of either short-term psychodynamic psychotherapy (STPP) or cognitive-behavioral therapy (CBT). Ratings were submitted to Q-type factor analysis to confirm the two groups. Regressive factor scores were rank ordered to describe the prototypes. These ideal models were correlated with ratings of actual therapy processes in two complete psychotherapy cases, one STPP and the other CBT. RESULTS: Agreement levels between expert ratings were high and the two ideal models were confirmed. As expected, the PQS ratings for actual STPP and CBT cases had significant correlations with their respective ideal models, but the STPP case also adhered to the CBT prototype. CONCLUSION: Overall, the findings reveal the adequacy of the prototypes for time-limited therapies, providing initial support of their validity.

Indícios de eficácia dos tratamentos psicoterápicos pelainternet: revisão sistemática / Evidences of efficacy of internet psychotherapeutic treatments: systematic review

A utilização das tecnologias de informação e comunicação em saúde mental é uma tendência crescente. Nos últimos anos, as pesquisas centraram-se sobre sua influência nos tratamentos psicoterápicos mediados pela internet. Este estudo realizou uma revisão sistemática de resultados dos tratamentos psicoterápicos online, a fim de verificar os indícios de sua eficácia. Buscas foram realizadas nas bases PsycINFO, Scielo e Periódicos da CAPES com os descritores "tratamento pela internet", "psicoterapia online", "telepsicologia" e "eficácia". Foram encontrados 16 estudos para análise final; os resultados indicam indícios de eficácia dessas intervenções para uma série de transtornos psicopatológicos. A terapia cognitivo comportamental foi a abordagem teórica mais utilizada nas intervenções. As intervenções online, com psicoterapeuta, foram superiores aos outros tipos de intervenções. Poucos trabalhos descreviam as características dos grupos controles e o treinamento dos psicoterapeutas. A heterogeneidade clínica e instrumentos de avaliação de resultados limitam a generalização dos achados e a comparação entre os estudos.

The use of information and communication technologies in mental health is a growing trend. In recent years, research has focused on its influence on internet-mediated psychotherapeutic treatments. This study conducted a systematic review of the results of online psychotherapeutic treatments to verify the indications of its efficacy. Searches were performed in the databases PsycINFO, Scielo and Periódicos da CAPES with the descriptors "treatment by the internet", "online psychotherapy", "telepsychology" and "effectiveness". Sixteen studies were found for final analysis; the results indicate evidence of efficacy of these interventions for many psychopathological disorders. Cognitive-behavioral therapy was the theoretical approach most used in the interventions. Online interventions with a psychotherapist were superior to other types of interventions. Few papers described the characteristics of the control groups and the training of psychotherapists. Clinical heterogeneity and outcome assessment tools limit the generalization of findings and comparison between studies.

Desenvolvimento e Relato de Experiência de um Protocolo de Primeiros Cuidados Psicológicos a Distância (PCPd) durante a Pandemia COVID-19 / Development and Experience Report of a Protocol of Psychological First Aid on line (PFAo) during the COVID-19 Pandemic

A pandemia e as medidas para conter sua propagação tiveram efeitos significativos na saúde mental da população em geral e na dos profissionais da linha de frente nos atendimentos. Como consequência, o impacto em saúde mental pode ser considerado uma nova emergência sanitária. No entanto, os protocolos de atendimento não foram desenvolvidos para o contexto atual. Portanto, o objetivo do presente estudo foi adaptar o protocolo de Primeiros Cuidados Psicológicos desenvolvido pela Organização Mundial da Saúde para a modalidade de atendimento a distância (PCPd), bem como, relatar a experiência de sua aplicação em termos de perfil dos atendidos, principais demandas e técnicas aplicadas, e encaminhamento. Foram realizados atendimentos usando o protocolo PCPd a 15 participantes classificados como em sofrimento psicológico em um estudo prévio realizado para levantamento de saúde mental. A maioria dos participantes era do gênero feminino (73%) e possuía histórico de doenças psiquiátricas (60%). Com relação às demandas, 87% (n=13) dos participantes relataram causas de sofrimento mental atreladas à pandemia, particularmente em função da sobrecarga decorrente do excesso de demandas nas atividades domésticas e de trabalho. Foram utilizadas técnicas de normalização e de resolução de problemas no atendimento em quase todos os casos. Devido a alta intensidade de estresse e de ansiedade foi necessário aplicar técnicas de respiração diafragmática em três casos e o teste de realidade em um caso. Com relação ao encaminhamento, 40% dos participantes já estavam em atendimento psicoterápico e os demais foram encaminhados. Salienta-se que 20% optou por modalidades online de encaminhamento. Por fim, o presente relato de experiência apresenta a adequação do PCPd às necessidades de cuidados psicológicos a distância diante da emergência causada pela pandemia, bem como, a potencialidade do protocolo adaptado em promover suporte inicial e encaminhamento a rede de saúde mental. Estudos experimentais e mais controlados poderão fornecer mais evidências da prática desenvolvida.(AU)

The pandemic and measures to contain its spread had major effects on the mental health of the general population and of frontline professionals. As a consequence, the impact on mental health can be considered a new healthcare emergency, but the healthcare protocols were not developed for the current context. Thus, the goal of the present study was to adapt the Psychological First Aid protocol developed by the World Health Organization to the online health service (PFAo), as well as to report the experience of its application in terms of patients profile, key demands and techniques used for treatment, and forwarding. Consultations were carried out using PFAo protocol to 15 participants classified as having psychological distress in a previous survey. Most participants were female (73%) and had a history of psychiatric illness (60%). Regarding the demands, 87% of participants reported that their primary causes of mental suffering were linked to the pandemic, particularly due to the overload resulting from the overwhelming demands in their home and work activities. Normalization and problem solving techniques were used during consultations in almost all cases. Due to intense stress and anxiety observed in participants, diaphragmatic breathing techniques were recommended to three patients and reality test was used to one. With regard to referral, 40% of participants were already receiving psychological care and the remaining ones were referred to local psychotherapists. About 20% of participants showed a preference for online referral modalities. Finally, the present experience report shows the adequacy of the PFAo to the needs of psychological online healthcare in the face of the emergency caused by the pandemic, as well as the potential of the adapted protocol to promote initial support and referral to mental health network. Experimental and more controlled studies may provide more evidence of the developed practice.(AU)

La pandemia y las medidas para contener su propagación tuvieron efectos importantes en la salud mental de la población en general y de los profesionales de primera línea. Como consecuencia, el impacto en la salud mental puede considerarse una nueva emergencia sanitaria, pero los protocolos sanitarios no se desarrollaron para el contexto actual. Así, el objetivo del presente estudio fue adaptar el protocolo de Primera Ayuda Psicológica desarrollado por la Organización Mundial de la Salud a la modalidad de atención a distancia (PAPd), así como reportar la experiencia de su aplicación en términos de perfil del paciente, demandas clave y técnicas utilizadas para el tratamiento y reenvío. Las consultas se llevaron a cabo mediante el protocolo PAPd a 15 participantes clasificados como con distrés psicológico. La mayoría de los participantes eran mujeres (73%) y tenían antecedentes de enfermedad psiquiátrica (60%). En cuanto a las demandas, el 87% de los participantes refirió que sus principales causas de sufrimiento mental estaban vinculadas a la pandemia, particularmente por la sobrecarga resultante de las abrumadoras demandas en sus actividades domésticas y laborales. Se utilizaron técnicas de normalización y resolución de problemas durante las consultas en casi todos los casos. Debido al intenso estrés y ansiedad observados en los participantes, se recomendaron técnicas de respiración diafragmática a tres pacientes y se utilizó una prueba de realidade a uno. En cuanto a el referimiento, el 40% de los participantes ya estaban recibiendo atención psicológica y los restantes fueron derivados a psicoterapeutas locales. Aproximadamente el 20% de los participantes mostró preferencia por las modalidades on line. Finalmente, el presente relato de experiencia muestra la adecuación del PAPd a las necesidades de la atención psicológica online ante la emergencia provocada por la pandemia, así como el potencial del protocolo adaptado para promover el apoyo inicial y lo referimiento a la red de salud mental. Los estudios experimentales y más controlados pueden proporcionar más evidencia de la práctica desarrollada.(AU)

Influência da percepção de risco sobre a COVID-19 no sofrimento psicológico dos profissionais de saúde / Influence of risk perception of COVID-19 on psychological distress of health professionals / Influencia de la percepción de riesgo del COVID-19 en el sufrimiento psicológico de los profesionales de la salud

A saúde mental dos profissionais de saúde da linha de frente durante a pandemia da doença coronavírus 2019 (COVID-19) está relacionada a uma percepção qualitativa de risco sobre a doença, segundo a Teoria do Traço Difuso. Uma pesquisa de levantamento foi realizada com 134 profissionais de saúde da linha de frente em um município da região metropolitana do Rio Grande do Sul. Os participantes responderam a um questionário on-line sobre percepção de risco e a Clinical Outcome Routine Evaluation - Outcome Measure. Análises de regressão linear corroboraram a literatura, indicando que a percepção qualitativa do risco estava relacionada a menor sofrimento psicológico e uma avaliação quantitativa, a maior sofrimento. Os resultados demonstraram a importância da Teoria do Traço Difuso para compreensão dos riscos associados ao sofrimento mental (potencialmente clínico) de profissionais de saúde durante a pandemia

Mental health of frontline health professionals during the coronavirus disease 2019 (COVID-19) pandemic is related to a qualitative perception of risk about the disease, according to Fuzzy Trace Theory. A survey was carried out with 134 frontline health professionals in a city within the metropolitan area of Rio Grande do Sul. Participants answered an online questionnaire on risk perception and the Clinical Outcome Routine Evaluation - Outcome Measure. Linear regression analysis corroborated the literature, indicating that a qualitative perception of risk was related to less psychological distress and, a quantitative assessment, to greater suffering. Results showed the importance of Fuzzy-Trace Theory for understanding the risks associated with (potentially clinical) psychological distress of health professionals during the pandemic

La salud mental de los profesionales de la salud de primera línea, durante la pandemia de enfermedad por coronavirus 2019 (COVID-19), está relacionada con una percepción cualitativa de riesgo sobre la enfermedad, según la Teoría del Rasgo Difuso. Se realizó una encuesta a 134 profesionales de la salud de primera línea en un municipio de la región metropolitana de Río Grande del Sur. Los participantes respondieron un cuestionario en línea sobre percepción de riesgo y la Clinical Outcome Routine Evaluation ­ Outcome Measure. Los análisis de regresión lineal corroboraron la literatura, indicando que la percepción cualitativa del riesgo se relacionó con un menor sufrimiento psicológico y, una valoración cuantitativa, con un mayor sufrimiento. Los resultados demuestran la importancia de la Teoría del Rasgo Difuso para comprender los riesgos asociados con el sufrimiento mental (potencialmente clínico) de los profesionales de la salud durante la pandemia

Relationship between childhood trauma, parental bonding, and defensive styles and psychiatric symptoms in adult life

Abstract Introduction A relationship between different types of childhood trauma, parental care, and defensive styles and development of psychiatric symptoms in adulthood is proposed in this study. Understanding the nature of this association is essential to assist psychotherapists who treat patients with a history of past trauma. This study aims to examine the associations between childhood trauma, parental bonding, and defensive styles and current symptoms in adult patients who sought care at an analytical psychotherapy clinic. Methods The sample comprised 197 patients from an analytically oriented psychotherapy clinic. Participants responded to four self-report instruments that assessed, respectively, presence and frequency of several types of early trauma, type of parental attachment, styles of defenses, and current symptoms encompassing a wide variety of psychopathological syndromes. Results Only 5% of patients reported not having experienced any traumatic experience in childhood. Several traumas such as emotional and physical abuse, emotional neglect, and physical neglect showed positive and significant associations with several dimensions of current symptoms, and also with parental bonding and defensive styles. When analyzed together with the other variables, defensive styles explained the level of psychological suffering caused by the symptoms. Conclusions This study offers additional support for understanding the associations between childhood trauma, parental bonding styles, and defense styles and the psychiatric symptoms of patients in analytically oriented psychotherapy.

Asociaciones entre contratransferencia y características del paciente en psicoterapia psicoanalítica / Associações entre contratransferência e características do paciente na psicoterapia psicanalítica / Associations between countertransference and patient characteristics in psychoanalytic psychotherapy

Resumen Objetivo: explorar las reacciones de contratransferencia de los terapeutas en la fase inicial de la psicoterapia psicoanalítica (entre las sesiones 4 y 5) y verificar las posibles asociaciones entre estas y las características personales del paciente (sociodemográficas, psicológicas y psicopatológicas). Método: estudio naturalista, transversal, correlacional y observacional con enfoque descriptivo-analítico. La muestra consta de 180 pares de pacientes y terapeutas, de los cuales 180 eran pacientes adultos (32.82 ± 12.66 años) y 48 terapeutas (32.69 ± 10.01 años). Resultados: la contratransferencia se ve afectada por la edad del paciente, los aspectos psicológicos de su vida anterior (traumas y apego parental) y elementos de su personalidad (habilidades de empatía y mecanismos defensivos), pero no por los síntomas que presenta. Conclusiones: los hallazgos respaldan la literatura científica, que señala la relevancia de las experiencias infantiles y las características de personalidad del paciente para evocar patrones específicos de contratransferencia en el terapeuta. Conocer tales relaciones puede ayudar a los clínicos a identificar sus propias reacciones y usarlas terapéuticamente, según corresponda.

Resumo Objetivo: explorar as reações contratransferenciais de terapeutas na fase inicial de psicoterapia psicanalítica (entre a 4a e a 5a sessão) e verificar possíveis associações destas com as características pessoais do paciente (sociodemográficas, psicológicas e psicopatológicas). Método: estudo naturalístico, transversal, correlacional e observacional de abordagem descritivo-analítica. A amostra é composta por 180 duplas paciente-terapeuta, dos quais 180 eram pacientes adultos (32,82 ± 12,66 anos de idade) e 48 terapeutas (32,69 ± 10,01 anos de idade). Resultados: a contratransferência é afetada pela idade do paciente, aspectos psicológicos da sua vida pregressa (traumas e vinculação parental) e elementos de sua personalidade (habilidades empáticas e mecanismos defensivos), mas não pelos sintomas. Conclusões: os achados apoiam a literatura científica, a qual sinaliza a relevância das experiências infantis e de características da personalidade do paciente na evocação de padrões contratransferenciais específicos no terapeuta. Conhecer tais relações pode ajudar os clínicos a identificar suas próprias reações emocionais e utilizá-las terapeuticamente, quando for o caso.

Abstract Objective: to explore therapists' countertransference reactions in the initial phase of psychoanalytic psychotherapy (between sessions 4 and 5) and to verify possible associations between these and the patient's personal characteristics (sociodemographic, psychological, and psychopathological). Method: naturalistic, cross-sectional, correlational, and observational study with a descriptive-analytical approach. The sample consists of 180 patient-therapist dyads, of which 180 were adult patients (32.82 ± 12.66 years old) and 48 therapists (32.69 ± 10.01 years old). Results: countertransference is affected by the patient's age, psychological aspects of his or her previous life (traumas and parental attachment) and elements of personality (empathetic skills and defensive mechanisms), but not by the showed symptoms. Conclusions: the findings support the scientific literature, which points to the relevance of childhood experiences and personality characteristics of the patient to evoke specific countertransference patterns in the therapist. Understanding such relationships can help clinicians identify their own reactions and deliver the therapy, as appropriate.