The right to dream: A cross-sectional look at poverty alleviation programs.

Studies on social programs reveal the absence of a cross-sectional perspective capable of identifying common aspects that improve the living conditions of their participants while also contributing to poverty alleviation. To detect such elements, we examined the transformations in the experiences and meanings associated with poverty and its alleviation by conducting semistructured interviews and focus groups with participants and intervention team members that implemented six social programs in Chile and Peru. We conducted a descriptive and relational analysis guided by Grounded Theory, which revealed three overarching elements: notions of poverty, notions of the overcoming of poverty, and changes necessary for overcoming poverty. Lastly, based on a complex view of poverty and considering the contributions of community psychology, we propose that interventions in this field must create meaningful relational spaces that restore participants' objective and subjective rights, such as the right to dream.

Sparks of psychotherapeutic change: How therapists understand moments of meetings' contribution to change in psychotherapy.

OBJECTIVE: : This study describes therapists' experience of moments of meeting with their patients in psychotherapy, and how these moments relate to the patient's change process. METHOD: 13 in-depth interviews conducted with therapists from different theoretical backgrounds were analyzed using Grounded Theory. RESULTS: Four categories were established: (1) Characteristics of moments of meeting, (2) Triggers of moments of meeting (3) Enabling conditions, and (4) Main effects of moments of meeting. A conceptual model was developed around an axial phenomenon that provides understanding on how moments of meeting contribute to the change process in psychotherapy, through the construction of shared relational knowing. DISCUSSION: : The value of moments of meeting for the therapeutic process is discussed and reflected upon, as well as their effect on changes regarding implicit relational knowing.

Care in social policies from a comprehensive perspective: A proposal to conceptualize and address it based on community and psychosocial praxis.

The literature establishes the importance of care in the context of situations leading to burnout. However, there are theoretical limitations that make it difficult to understand its role within the social area. The article presents a proposal to conceptualize and address care in social policies from a comprehensive perspective, based on the community praxis of psychosocial teams. Results came from evaluating a care intervention with 35 participants from three teams focused on homeless people and two teams that worked with relatives of prison inmates. Interviews and focus groups were held, which were then analyzed Grounded Theory methods. As for the questions "Who is being taken care of?" and "Who is in charge of providing care?," four instances were defined: Workers, teams, self-care, and joint care. The article discusses the scope and theoretical challenges of care, as well as the key role played by institutions in care in community-based professional praxis. In addition, the authors reflect on the importance of comprehensive care for community psychology in today's social interventions.

Recognizing states of psychological vulnerability to suicidal behavior: a Bayesian network of artificial intelligence applied to a clinical sample.

BACKGROUND: This study aimed to determine conditional dependence relationships of variables that contribute to psychological vulnerability associated with suicide risk. A Bayesian network (BN) was developed and applied to establish conditional dependence relationships among variables for each individual subject studied. These conditional dependencies represented the different states that patients could experience in relation to suicidal behavior (SB). The clinical sample included 650 mental health patients with mood and anxiety symptomatology. RESULTS: Mainly indicated that variables within the Bayesian network are part of each patient's state of psychological vulnerability and have the potential to impact such states and that these variables coexist and are relatively stable over time. These results have enabled us to offer a tool to detect states of psychological vulnerability associated with suicide risk. CONCLUSION: If we accept that suicidal behaviors (vulnerability, ideation, and suicidal attempts) exist in constant change and are unstable, we can investigate what individuals experience at specific moments to become better able to intervene in a timely manner to prevent such behaviors. Future testing of the tool developed in this study is needed, not only in specialized mental health environments but also in other environments with high rates of mental illness, such as primary healthcare facilities and educational institutions.

"I couldn't change the past; the answer wasn't there": A case study on the subjective construction of psychotherapeutic change of a patient with a Borderline Personality Disorder diagnosis and her therapist.

BACKGROUND: Qualitative research has provided knowledge about the subjective experiences of therapists and patients regarding the psychotherapy process and its results. Only few studies have attempted to integrate both perspectives, considering the influence of a patient's characteristics and diagnosis in the construction of this experience. AIM: To identify aspects of psychotherapy that contribute to therapeutic change based on the experience of a patient and her therapist, and to construct an integrated comprehension of the change process of a patient with Borderline Personality Disorder. METHOD: A single case was used to carry out a qualitative analysis of follow-up interviews of the participants of a long-term psychotherapy. Two qualitative approaches were combined into a model entitled "Discovery-Oriented Biographical Analysis" to reconstruct an integrated narrative. RESULTS: This method yielded an integrated narrative organized into four "chapters" that reflect the subjective construction of both the patient's and the therapist's experience of psychotherapy in terms of meaning. DISCUSSION: The understanding of psychotherapy as a multilevel process, in which different themes occur and develop simultaneously, is discussed. From this perspective, psychotherapy can be characterized as a process that involves the recovery of trust in others through corrective emotional experiences and the construction of a shared implicit relational knowledge. Clinical or methodological significance of this article: Research on the subjective experiences of psychotherapy must consider both patient and therapist as privileged but always complementary witnesses of their interaction. In addition, it should be noted that the experience of studying this biographical reconstruction generates a space where research and practice converge. The analysis of participants' narratives provides fascinating windows into their perceptions of psychotherapy and the process of change (Safran, 2013); here, the researcher is not merely a advantaged observer or a good summarizer: He/she has the chance to imbue the psychotherapy with a new meaning by connecting it with a common set of knowledge and a body of socially shared experience.

[Suicide in lesbian, gay, bisexual and trans populations: systematic review of a decade of research (2004-2014)]. / Suicidio en poblaciones lesbiana, gay, bisexual y trans: revisión sistemática de una década de investigación (2004-2014).

UNLABELLED: Lesbian, gay, bisexual and trans (LGBT) populations have a high prevalence of suicide behaviors. AIM: To review the literature on suicide among LGBT populations. MATERIAL AND METHODS: A systematic review of the scientific literature published between 2004 and 2014 on suicidality among LGBT people was conducted. Forty-five articles were selected for a thematic analysis. RESULTS: The research on suicide among LGBT people has increased during the last decade. The vast majority of studies have been conducted in the U.S. and other English speaking countries. At the same time, in a great part, these studies have been published in journals specializing in mental health and public health of sexual minorities. In general, they provide a significant foundation on protective and risk factors for suicide as well as their epidemiology. CONCLUSIONS: The focus of research on suicide among LGBT populations is mainly exploratory. More attention on these at-risk groups is required from the suicide research community in order to provide useful evidence for prevention and development of focalized and effective interventions.

[Return to work enablers for workers with work-related mental illness]. / Facilitadores del reintegro laboral en trabajadores con patología mental de origen laboral: una revisión sistemática.

BACKGROUND: There is growing interest in the treatment and return-to-work of workers with labor related mental illnesses. AIM: To perform a systematic review of practices and interventions that improve return to work. MATERIAL AND METHODS: Systematic literature review. Thirty articles were selected for in- depth analysis. RESULTS: Self efficacy perception, work motivation, a lower age and a better socioeconomic status were identified as worker-related return to work facilitators. Among work environment facilitators, good communication practices, supervisor support, a good assessment and modification of work load, adjustment of expectations, a good relationship between employers and employees and positive work experiences were identified. Treatment may improve return to work using a multidisciplinary approach, reducing stress and identifying psychosocial determinants of mental problems rather than symptoms and providing a timely health care. CONCLUSIONS: Return to work of workers with labor related mental illnesses requires a constant sharing of information between health care workers, employers and employees to identify common therapeutic objectives.

[Barriers restricting postpartum depression treatment in Chile]. / Barreras de acceso a tratamiento de la depresión posparto en Centros de Atención Primaria de la Región Metropolitana: un estudio cualitativo.

BACKGROUND: In Chile, postpartum depression is a prevalent and disabling condition. Universal screening is available but has not been translated into better treatment rates, suggesting the existence of access barriers. AIM: To describe access barriers to postpartum depression treatment in six primary health care clinics in Metropolitan Santiago, Chile. MATERIAL AND METHODS: Twenty women with postpartum depression and 18 primary health care professionals were subjected to a semi-structured interview. A qualitative methodology based on Grounded Theory was used. RESULTS: There are user associated barriers such as lack of knowledge about the disease, a negative conceptualization and rejection of available treatment options. There are also barriers associated with poor network support and some features of the health care system such as long waiting times and lack of coordination between clinical and administrative decisions. CONCLUSIONS: Patient and provider related barriers restricting treatment of postpartum depression were identified.

[Learning during the early clinical years takes more than good study habits: Perceptions of students and teachers]. / Estrategias del aprendizaje inicial de la clínica: más allá de los hábitos de estudio. Percepciones de estudiantes y docentes clínicos.

BACKGROUND: Teaching methods of the undergraduate medical curriculum change considerably from the first years to clinical training. Clinical learning occurs in complex and varied scenarios while caring for patients. Students have to adapt their learning approaches and strategies to be able to integrate theory and clinical practice and become experiential learners. AIM: To identify the strategies used by medical students to learn during the initial clinical years, as reported by students themselves and by their clinical tutors. MATERIAL AND METHODS: We performed eight focus group discussions with 54 students enrolled in years three to six and we interviewed eight clinical tutors. Both focus group discussions and interviews were audio recorded, transcribed and analyzed according to Grounded Theory. RESULTS: Four main themes were identified in the discourse of both students and tutors: Strategies oriented to theoretical learning, strategies oriented to experiential learning, strategies for integrating theory and practice and strategies oriented to evaluation. The mentioning of individual differences was present across the reports of both students and tutors. CONCLUSIONS: Students use a rich variety of strategies to face the challenges of clinical learning. Both students and tutors recognize that the learning approaches and strategies vary according the nature of the task and individual differences. The responses of students bring particular knowledge of the approaches used for the theoretical and practical integration and delve into the social dimension of learning.

The sound of change: a study of the psychotherapeutic process embodied in vocal expression. Laura Rice's ideas revisited.

OBJECTIVE: The purposes of this article were to compare the characteristics of the vocal quality of therapists and patients in change and stuck episodes, and to depict patient-therapist interaction sequences of vocal properties, in order to analyze micro-regulatory processes within the psychotherapeutic interaction. METHOD: Application of the Vocal Quality Patterns coding system to a study of a sample of change and stuck episodes, taken from six psychotherapies. RESULTS: The results made it possible to show that the 15 psychotherapeutic change process are embodied in the modes of vocal expression of their participants, and that the way in which these different modes are coordinated within the interaction makes it possible to observe regulatory micro-sequences that participate in the therapeutic change process.

[Perceptions of students and teachers about clinical medicine learning]. / ¿Cómo aprenden los estudiantes de medicina en la transición hacia el ciclo clínico? Estudio cualitativo de las percepciones de estudiantes y docentes acerca del aprendizaje inicial de la clínica.

BACKGROUND: The transition to the clinical courses represents a major challenge for medical students who are expected to become experiential learners, able to integrate theory and practice in the context of patient care. There are questions about how students face this challenge. AIM: To understand and compare the perceptions of students and clinical tutors on how medical students learn during the transition to the clinical levels of the curriculum. MATERIAL AND METHODS: We performed eight focus group discussions with 54 students enrolled in years three to seven and we interviewed eight clinical tutors. Both students' focus group discussions and tutors' interviews were audio recorded, transcribed and analyzed according to the Grounded Theory. RESULTS: Nine main themes emerged from the analysis of students' opinions and six from the tutors' views. The following themes were common to both students and educators: educational activities, actors, clinical settings, learning strategies, transition markers and tutor's role. Educators emphasized the importance of curricular courses' design and students, that of emotions, adaptation and self-care strategies, and threats to learning. CONCLUSIONS: There is a common core of students' and clinical tutors' perceptions about the relevance of practical activities, social interactions and context in the development of students' learning and adaptation strategies during the transition to the clinical levels of the curriculum. These results are related to social and cultural theories of learning. Thus we propose a model for early clinical learning that might help to stimulate the reflection of students and medical educators regarding clinical learning and contribute to the development of interventions that improve the clinical learning and teaching practices.

Mental telehealth in a public child and adolescent psychiatry unit during the pandemic: a qualitative implementation study. / Telesalud mental en una unidad pública de psiquiatría infanto-juvenil en pandemia: estudio cualitativo de implementación.

Background: The COVID-19 pandemic led to a prompt implementation of remote care, especially in mental health care. The evidence supporting this modality of care is still emerging, with few qualitative studies describing its implementation in Latin American countries. This study aims to understand the perspectives of therapists and patients regarding the use of telehealth in a child and adolescent mental health unit of a Chilean public service. Methods: This is a qualitative study. Two focus groups were defined with 14 professionals, and 16 in-depth interviews were conducted with users of an outpatient child and adolescent psychiatry unit. The data were analyzed using the grounded theory model. Results: In the group of therapists, four main categories emerged: background of mental telehealth, implementation, mental telehealth from the therapist's position, and projections. Three main categories emerged in the patient's group: implementation, evaluation of mental telehealth users, and projections. Conclusions: There are elements in common between the opinions of patients and therapists. Something to note within the patient's group is that, despite accepting remote care and recognizing its positive aspects, aside from the pandemic context, they prefer face-to-face or mixed care.

Antecedentes: La pandemia por COVID-19 generó una implementación súbita de las atenciones a distancia, especialmente en atenciones de salud mental. La evidencia que sustenta esta modalidad de atención es aún emergente, con escasos estudios cualitativos que representen su implementación en países latinoamericanos. El objetivo de este trabajo es conocer la perspectiva de terapeutas y de usuarios, respecto del uso de la telesalud en una unidad de salud mental infantil y de la adolescencia de un servicio público chileno. Métodos: Estudio cualitativo. Se establecieron dos grupos focales con 14 profesionales en total, y 16 entrevistas en profundidad con usuarios de una unidad ambulatoria de psiquiatría infanto juvenil.. Los datos se analizaron utilizando el modelo de teoría fundamentada. Resultados: En el grupo de terapeutas surgen cuatro categorías fundamentales; antecedentes de la telesalud mental, implementación, telesalud mental desde la posición del terapeuta y proyecciones. En el grupo de usuarios surgieron tres categorías principales: implementación, evaluación de los usuarios de la telesalud mental y proyecciones. Conclusiones: Existen elementos en común entre la opinión de los usuarios y terapeutas. Un elemento importante dentro del grupo de los usuarios es que, a pesar de aceptar la atención remota y reconocer aspectos positivos en esta, fuera del contexto de pandemia prefieren atenciones presenciales o mixtas.

Broadening the evidentiary basis for clinical practice guidelines: Recommendations from qualitative psychotherapy researchers.

To improve the provision of psychotherapy, many countries have now established clinical practice guidelines for the treatment of specific disorders and mental health concerns. These guidelines have typically been based on evidence from meta-analyses of randomized clinical trials with minimal consideration of findings from qualitative research designs. This said, there has been growing interest in incorporating qualitative research in guideline development processes from both stakeholders and guideline development bodies. In this international collaboration, 19 qualitative psychotherapy researchers from 10 countries articulated the benefits of including qualitative findings within the guideline development process and generated recommendations for guideline developers. The underlying question of this report was "Why and how should qualitative research be used in efforts to develop guidance for psychotherapy practice?" The advantages of reviewing qualitative findings included the ability to identify treatment patterns at the level of in-session dynamics, cultural contexts, interpersonal relationships, and internal experiences, thereby creating guidance that is responsive to clients' needs in the moment-to-moment therapy process. Recommendations are offered at the systemic level (e.g., guideline formation processes, methods of education, research funding priorities). Also, methodological advice is offered for guideline developers when selecting to incorporate qualitative research in the implementation of an expanded guideline development process. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Identification of Dynamic Patterns of Personal Positions in a Patient Diagnosed With Borderline Personality Disorder and the Therapist During Change Episodes of the Psychotherapy.

Personal positions and voices of a patient diagnosed with borderline personality disorder (BPD) and the therapist during long-term psychotherapy were studied aiming to find differences in the patterns formed in these aspects of subjectivity according to the level of elaboration of the change episodes achieved by the patient. This case study considered a stage of qualitative analysis where change episodes of the patient were traced through the Change Episodes Model. Later, through the Model of Analysis of Discursive Positioning in Psychotherapy (MAPP), the voices and personal positions of the patient and her therapist were identified in each of the change episodes. In the stage of quantitative analysis, dynamic patterns in the voices and personal positions were established, accounting for hypothetical attractors using the Space State Grid (SSG) technique in each of the three different levels of subjective elaboration that constitute the change episodes. The results established differentiated dynamic patterns in the change episodes, coherent with the patient's change process, and formation of propositive/reflective specific patterns as the patient evolved in the three different levels of subjective elaboration. The above suggests that a subjective transformation process is displayed, and this is manifested in the different voices and personal positions that emerged as the change episodes evolve. The identified dynamic patterns can be considered nonlinear and emergent subjective exchanges between the patient and the therapist throughout the psychotherapy.

Adolescence and Suicide: Subjective Construction of the Suicidal Process in Young Gay and Lesbian Chileans.

The association between suicide risk and sexual minority status can be understood from the perspective of the social determinants of health, an approach that requires the development of culturally sensitive knowledge. The aim of this study was to characterize young gay and lesbian people's subjective construction of their experience of having lived and survived a suicidal process. Qualitative interviews were conducted and analyzed as products based on life events. In the participants' accounts, we identified hostile contexts associated with suicide, trajectories associated with gay/lesbian identification processes, and milestones related to victimization experiences as part of the intentionality and rationality of suicide.

Clients', therapists', and observers' agreement on the amount, temporal location, and content of psychotherapeutic change and its relation to outcome.

Clients', therapists', and observers' identification of change was studied in 27 therapeutic processes, and agreement on the amount, temporal location, and content of change was related to outcome. Results show that clients reported more changes in successful therapies. Client-therapist temporal match of change moments was low irrespective of outcome. Results from all three perspectives were consistent in that manifestation of new behaviors and emotions was the most representative content of change among all therapies. Meanwhile, client-therapist agreement on the frequency of grouped change indicators reported was associated with positive outcome, whereas client-observer agreement was related to negative outcome. Therapists and observers agreed in both successful and nonsuccessful therapies. The relationship between agreement and therapeutic outcome is discussed in relation to each dimension of analysis.

Analysis of verbalized emotions in the psychotherapeutic dialogue during change episodes.

As described by many theorists, emotional expressions contribute to the activation and regulation of personal emotional experiences and communicate something about internal states and intentions. These emotional expressions can be observed in the words used in our speech and nonverbal behaviors, even when nonverbal behaviors are synchronized to one's own speech or to the speech of others. Using a quantitative and qualitative methodology, this article reports a classification of verbal emotional expressions of both psychotherapists and patients in change episodes. Assuming that the emotions loaded in linguistic contents are explicit emotions shown by emotion words, this methodology allows for a complete and differentiating assessment of affective qualities in both patients and psychotherapists during the psychotherapeutic dialogue.

Using the Generic Model of Psychotherapy to Develop a Culturally-Sensitive Approach to Psychotherapy With Sexual and Gender Minority Patients.

This article discusses how the Generic Model of Psychotherapy (Orlinsky and Howard, 1987) can help to organize the psychotherapy research and the knowledge in the field of psychotherapy for sexual and gender minority patients. The structure that this traditional model provides is a good foundation for research in this field, inasmuch as it stresses macrosocial aspects that determine the provision of psychotherapy and contextualize its outcomes. Each one of the main components offered by the Generic Model of Psychotherapy - Determinants, Processes, and Consequences - are specified for psychotherapy with LGBT patients and are illustrated with a selection of already existing research in the field of sexual minorities; they are also stress areas marked by knowledge gaps that require future developments. In addition, a set of questions are proposed to contribute to new studies, including the clinical implications that can be derived from this model.

Episodes of meeting in psychotherapy: an empirical exploration of patients' experiences of subjective change during their psychotherapy process.

This study aims to assess moments of meeting in psychotherapy -understood as moments of intense connectedness and intimacy, shared between patient and therapist during any therapeutic encounter that enable a spin in the therapy process- using a qualitative interview with patients who were undergoing or had finished psychological treatment. Micro-pehenomenological interviews were conducted with nine patients who were undergoing or had finished psychological treatment. Transcriptions of the interviews were subject to micro-phenomenological analysis. A general structure of episodes of meeting showing their temporal evolution was identified and divided into six consecutive phases. These findings suggest that episodes of meeting in psychotherapy are lived and remembered by patients in a significant way; they are emotionally charged and have a meaning for each participant. Also, emotional and nonverbal cues seem to be highly relevant features. Moments of meeting could be understood as implicit mechanisms that allow changes in the implicit relational domain.

Telesalud mental en una unidad pública de psiquiatría infanto-juvenil en pandemia: estudio cualitativo de implementación / Mental telehealth in a public child and adolescent psychiatry unit during the pandemic: a qualitative implementation study

Antecedentes La pandemia por COVID-19 generó una implementación súbita de las atenciones a distancia, especialmente en atenciones de salud mental. La evidencia que sustenta esta modalidad de atención es aún emergente, con escasos estudios cualitativos que representen su implementación en países latinoamericanos. El objetivo de este trabajo es conocer la perspectiva de terapeutas y de usuarios, respecto del uso de la telesalud en una unidad de salud mental infantil y de la adolescencia de un servicio público chileno. Métodos Estudio cualitativo. Se establecieron dos grupos focales con 14 profesionales en total, y 16 entrevistas en profundidad con usuarios de una unidad ambulatoria de psiquiatría infanto juvenil.. Los datos se analizaron utilizando el modelo de teoría fundamentada Resultados En el grupo de terapeutas surgen cuatro categorías fundamentales; antecedentes de la telesalud mental, implementación, telesalud mental desde la posición del terapeuta y proyecciones. En el grupo de usuarios surgieron tres categorías principales: implementación, evaluación de los usuarios de la telesalud mental y proyecciones. Conclusiones Existen elementos en común entre la opinión de los usuarios y terapeutas. Un elemento importante dentro del grupo de los usuarios es que, a pesar de aceptar la atención remota y reconocer aspectos positivos en esta, fuera del contexto de pandemia prefieren atenciones presenciales o mixtas.

Background The COVID-19 pandemic led to a prompt implementation of remote care, especially in mental health care. The evidence supporting this modality of care is still emerging, with few qualitative studies describing its implementation in Latin American countries. This study aims to understand the perspectives of therapists and patients regarding the use of telehealth in a child and adolescent mental health unit of a Chilean public service. Methods This is a qualitative study. Two focus groups were defined with 14 professionals, and 16 in-depth interviews were conducted with users of an outpatient child and adolescent psychiatry unit. The data were analyzed using the grounded theory model. Results In the group of therapists, four main categories emerged: background of mental telehealth, implementation, mental telehealth from the therapist's position, and projections. Three main categories emerged in the patient's group: implementation, evaluation of mental telehealth users, and projections. Conclusions There are elements in common between the opinions of patients and therapists. Something to note within the patient's group is that, despite accepting remote care and recognizing its positive aspects, aside from the pandemic context, they prefer face-to-face or mixed care.