Taking outside in, turning inside out: Exploring social dimensions and psychotherapeutic process in the play therapy of a young girl in foster care.

This paper, a collaborative effort, describes the work of A Home Within (AHW), a volunteer community-based organization providing pro-bono long term psychotherapy to current and former foster youth. We provide a brief description of the treatment model, present a report of treatment conducted by an AHW volunteer, and discuss further reflections on the societal context of our psychoanalytically-informed work. In-depth psychotherapeutic process from the treatment of a young girl in a pre-adoptive foster placement elucidates the psychotherapeutic possibilities when a psychoanalytic treatment model is accessible to current and former foster youth, usually deprived of this form of treatment due to overburdened, underfunded community mental health systems in the U.S. Open-ended psychotherapy afforded this traumatized child an unusual opportunity to work through past relational traumas in order to form new and more secure attachment relationships. We reflect further on the case from the vantage points of both the psychotherapeutic process and the greater societal context of this community-based program.

A invenção de um setting on-line para atendimento psicológico remoto / The invention of an online environment for remote psychological care / La invención de un entorno en línea para la atención psicológica remota

Com o advento da covid-19, foi declarado estado de emergência de saúde pública e decretadas medidas de isolamento e distanciamento social para conter a propagação da doença. O Conselho Federal de Psicologia, considerando a importância do acolhimento seguro durante a pandemia, publicou a Resolução CFP nº 4/2020, permitindo que serviços psicológicos aconteçam de maneira remota. O presente estudo visa, através do Método da Cartografia, apresentar a construção de um setting on-line para intervenções grupais e os desafios na oferta de acolhimento e atendimento remoto. Foram ofertados grupos terapêuticos, por meio da plataforma Google Meet, para estudantes da Universidade Federal Rural do Rio de Janeiro. Um diário de bordo foi produzido para acompanhar as forças que atravessavam e constituíam o território e a experiência grupal remota. Compreendemos que o território-espaço-grupal-on-line era composto pelo espaço virtual em que nos reuníamos, pelos espaços individuais de cada integrante e pelas forças que os atravessavam. Observamos que nem sempre os participantes dispunham de um lugar privado, mas estiveram presentes no encontro com câmeras e áudios abertos e/ou fechados e/ou através do chat da videochamada. A participação no grupo funcionou como alternativa no momento de distanciamento social, sendo uma possibilidade para o atendimento psicológico em situações de dificuldade de encontros presenciais; entretanto, se mostrou dificultada em diversos momentos, pela falta de equipamentos adequados e instabilidade na internet, fatores que interferiram nas reuniões e impactaram na possibilidade de falar e escutar o que era desejado.(AU)

With the advent of COVID-19, a state of public health was declared, and measures of isolation and social distance to contain the spread of the disease was decreed. The Federal Council of Psychology, considering the importance of safe reception during the pandemic, published CFP Resolution No. 4/2020, allowing psychological services to happen remotely. This study narrates, via the Cartography Method, the experience of inventing an Online Setting for group reception. Therapeutic groups were offered, via Google Meet Platform, to students at the Federal Rural University of Rio de Janeiro. A logbook was produced to accompany the forces that crossed and constituted the territory and the remote group experience. We understand that the territoryspace-group-online was composed by the virtual-space that we gathered, by the individualspaces of each member and by the forces that crossed them. We observed that the participants did not always have a private place, but they were present at the meeting with open and/or closed cameras and audio and/or through the video call chat. Participation in the group worked as an alternative at the time of social distancing, being a possibility for psychological care in situations of difficulty in face-to-face meetings, however, it proved to be difficult at various times, due to the lack of adequate equipment and instability on the internet, factors that interfered in meetings and impacted the possibility of speaking and listening to what was desired.(AU)

La llegada de la COVID-19 produjo un estado de emergencia de salud pública, en el que se decretaron medidas de confinamiento y distanciamiento físico para contener la propagación de la enfermedad. El Consejo Federal de Psicología, considerando la importancia de la acogida segura durante la pandemia, publicó la Resolución CFP nº 4/2020, por la que se permite la atención psicológica remota. Este estudio tiene por objetivo presentar, mediante el método de la Cartografía, la elaboración de un escenario en línea para la intervención grupal y los desafíos en la oferta de acogida y atención remota. Grupos terapéuticos se ofrecieron, en la plataforma Google Meet, a estudiantes de la Universidad Federal Rural de Río de Janeiro. Se elaboró un diario para acompañar a las fuerzas que atravesaron y constituyeron el territorio y la experiencia remota del grupo. Entendemos que el territorio-espacio-grupo-en línea estaba compuesto por el espacio-virtual que reunimos, por los espacios individuales de cada integrante y por las fuerzas que los atravesaban. Observamos que los participantes no siempre tenían un lugar privado y que estaban presentes en la reunión con cámaras y audio abiertos y/o cerrados y/o por el chat de la videollamada. La participación en el grupo funcionó como una alternativa en el momento del distanciamiento físico y revela ser una posibilidad de atención psicológica en situaciones de dificultad en los encuentros presenciales, sin embargo, se mostró difícil en varios momentos, ya sea por la falta de medios adecuados o por inestabilidad en Internet, factores que interferían en las reuniones e impactaban en la posibilidad de hablar y escuchar lo que se deseaba.(AU)

Conhecimento, recomendação e uso de mindfulness por psicólogos clínicos brasileiros / Knowledge, recommendation and use of mindfulness by brazilian clinical psychologists / Conocimiento, recomendación y uso de mindfulness por psicólogos clínicos brasileños

Mindfulness tem se tornado popular na comunidade psicoterapêutica e, também, entre clientes em busca de alívio para seu sofrimento. Contudo, pouco se conhece sobre como mindfulness tem sido integrado à psicoterapia, especialmente no Brasil. O objetivo deste estudo foi identificar e caracterizar conhecimento, recomendação, uso clínico e pessoal de mindfulness por psicólogos clínicos brasileiros. Os dados foram obtidos utilizando levantamento quantitativo nacional, realizado com 417 psicólogos clínicos habilitados. O instrumento utilizado foi um questionário estruturado online, desenvolvido e testado para este estudo. Os resultados foram analisados descritivamente por meio de frequências; para a associação entre categorias de respostas utilizou-se teste exato de Fisher e nível de significância p < 0,05. Os resultados indicaram que a maior parte dos psicólogos (65,23%) relatou nenhum ou pouco conhecimento de mindfulness; quase metade (47,96%) já recomendou a seus clientes; cerca de um terço (31,18%) já aplicou na clínica, predominando o uso de técnicas isoladas com clientes individualmente; e cerca de um quarto dos profissionais (25,37%) pratica mindfulness a nível pessoal. Estes dados sugerem que o uso de mindfulness na clínica tem se distanciado do formato baseado em evidência - programas baseados em mindfulness -, cuja eficácia já foi verificada. Espera-se que os resultados contribuam para a reflexão acerca da capacitação e da regulamentação de práticas emergentes em psicologia (incluindo mindfulness) por parte dos campos regulatório, acadêmico e científico, qualificando o psicólogo para tomar melhores decisões sobre a integração de tais práticas na psicoterapia.(AU)

Mindfulness has become popular within psychotherapeutic community and among clients seeking relief from their suffering. However, little is known about how mindfulness has been integrated into psychotherapy, especially in Brazil. This study aimed to identify and characterize knowledge, recommendation, clinical and personal use of mindfulness by Brazilian clinical psychologists. Data were obtained using a national quantitative survey, carried out with 417 licensed clinical psychologists. The instrument was a structured online questionnaire, developed and tested for this study. Results were analyzed descriptively by frequencies; Fisher's exact test and significance level p < 0.05 were used for association between categories of response. Results indicated that most psychologists (65.23%) reported no or little knowledge of mindfulness; almost half of them (47.96%) have already recommended it to their clients; about a third (31.18%) has already applied it in clinical setting, mainly using isolated techniques on individual clients; and about a quarter of the professionals (25.37%) practices mindfulness at a personal level. These data suggested that the use of mindfulness in clinical setting has moved away from the evidence-based format - mindfulness-based programs -, whose effectiveness has been verified. We expect that results can contribute to the reflection about training and regulation of emerging practices in psychology (including mindfulness) on the part of regulatory, academic, and scientific fields, qualifying the psychologist to make better decisions about integrating such practices in psychotherapy.(AU)

Mindfulness se ha vuelto popular dentro de la comunidad psicoterapéutica y entre los clientes que buscan alivio de su sufrimiento. Sin embargo, se sabe poco sobre cómo mindfulness se ha integrado en la psicoterapia. El objetivo de este estudio fue identificar y caracterizar conocimiento, recomendación, uso clínico y personal de mindfulness por parte de psicólogos clínicos brasileños. Se realizó una encuesta cuantitativa nacional con 417 psicólogos clínicos utilizando un cuestionario estructurado online, desarrollado y probado para este estudio. Los resultados se analizaron estadísticamente por frecuencias; la asociación entre categorías de respuestas se analizó utilizando la prueba exacta de Fisher y significación estadística de p < 0,05. Los resultados indicaron que la mayoría de los psicólogos (65.23%) informaron poco o ningún conocimiento de mindfulness; casi la mitad (47.96%) ya lo ha recomendado a sus clientes; aproximadamente un tercio (31.18%) ya lo ha aplicado en el entorno clínico, con el uso principal de técnicas aisladas en clientes individuales; y aproximadamente una cuarta parte (25.37%) de los profesionales tienen una práctica personal de mindfulness. Los datos sugirieron que el uso de mindfulness en la clínica se ha alejado del formato basado en la evidencia a través del cual se ha verificado su eficacia. Se espera que los resultados contribuyan a la reflexión por parte de los campos regulatorio, académico y científico sobre la formación y regulación de las prácticas emergentes en psicología (incluido el mindfulness), calificando al psicólogo para tomar mejores decisiones sobre la integración de tales prácticas en la psicoterapia.(AU)

"Recovering With Nature": A Review of Ecotherapy and Implications for the COVID-19 Pandemic.

Connection with nature has been considered beneficial for psychological well-being since times of evolution. Differences in Indian and Western thoughts have viewed natural elements in different lights, varying between eco-centrism to anthropocentrism. The intrusion of technology and digitalized lives as a result of globalization has decreased connectedness with nature. Ecotherapy is a novel form of psychotherapeutic technique based on explicit environmental or ecological interventions. Social and therapeutic horticulture, animal-assisted interventions, care farming, green exercise, environmental conservation and wilderness therapy are some of the ecosystem-based approaches used in mental health. Based on the principles of positive and client-centered psychology, ecotherapy-related techniques have been shown to be effective in medical disorders like hypertension, obesity, post-surgical recovery and psychosocial conditions like depression, stress reduction, post-traumatic stress disorder (PTSD), attention deficit hyperkinetic disorder (ADHD) and adjustment disorders. The principles of ecotherapy have been integrated into other psychotherapeutic techniques for better efficacy. This review attempts provides an overview of techniques, applications and challenges related to ecotherapy in psychology. The implications of its use during the ongoing Coronavirus 2019 (COVID-19) crisis, social isolation and consequent psychosocial aftermath are also discussed.

O Desenho na Gestalt-Terapia: A Versatilidade dos Traços em Interface com a Prática Clínica / The Drawing in Gestalt-Therapy: The Versatility of the Lines Interfacing the Clinical Practice / El Dibujo en Terapia Gestalt: La Versatilidad de los Trazos en Interfaz con la Práctica Clínica

Por meio de revisão integrativa de literatura, objetivou-se discutir a utilização do desenho na prática clínica em Gestalt-terapia. Consta do final dos anos de 1800 o primeiro estudo sobre os desenhos infantis. As teorias clássicas descrevem o desenvolvimento do grafismo por meio de estágios que são superados à medida que a criança se desenvolve. Na ciência psicológica, inicialmente, o desenho foi utilizado em testes psicológicos para medir aspectos cognitivos e, posteriormente, como técnica projetiva. Atualmente, ele também é utilizado como um meio para a investigação diagnóstica em diversas abordagens teóricas. Na Gestalt-terapia, o desenho pode ser utilizado como técnica, experimento e instrumento para o estabelecimento de vínculo, fundamentado no método fenomenológico. O desenho é uma importante ferramenta terapêutica que ao ser utilizada dentro de um processo psicoterapêutico consistente, fundamentado no vínculo de confiança e pautado no arcabouço teórico da Gestalt-terapia, é capaz de contribuir para o processo de atualização e de crescimento do cliente. (AU)

Through an integrative literature review, the goal is to discuss the use of drawings on the clinical practice of Gestalt-therapy. The first study regarding children's drawings refers to the ending of the 1800's. The classical theories describe the development of the graphism through stages that are overcome as the child develops. In psychological science, initially, the drawing was used in psychological tests to measure cognitive aspects, and, further on, as a projective technique. Currently, it is also used as a manner of investigations for diagnosis in various theories. In Gestalt-therapy the drawing can be used as a technique, an experiment and an instrument to establish bonding, based on the phenomenological method. The drawing is an important therapeutic tool that, when used within a consistent psychotherapeutic process, founded on a tie of trust and based on the theoretical background of Gestalt-therapy, is capable of contributing to the update and growth process of the client. (AU)

Por medio de una revisión integradora de literatura, se objetivó discutir la utilización del dibujo en la práctica en clínica en terapia Gestalt. Se pudo encontrar el primer estudio cerca los dibujos infantiles al final de los 1800. Las teorías clásicas describen el desarrollo del grafismo a través de etapas que son rebasadas con el desarrollo de los niños. En la ciencia psicológica, inicialmente, el dibujo fue utilizado en pruebas psicológicas, para medir aspectos cognitivos y, después, como una técnica de proyección. Actualmente, también se pone como una forma de investigación diagnóstica en las teorías diversas. En la terapia Gestalt, el dibujo puede ser usado como técnica, para experimentación y instrumento de formación de vínculo, fundamentado por el método fenomenológico. El dibujo es una herramienta significativa que, cuando utilizada en un proceso psicoterápico consistente, fundamentado en un vínculo de confianza y basado en la teoría de la terapia Gestalt, puede contribuir con el proceso de actualización y crecimiento del cliente. (AU)

Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial.

OBJECTIVE: Despite the heightened urgency of the current prescription opioid crisis, few psychotherapies have been evaluated for chronic pain patients receiving long-term opioid analgesics. Current psychological pain treatments focus primarily on ameliorating negative affective processes, yet basic science suggests that risk for opioid misuse is linked with a dearth of positive affect. Interventions that modulate positive psychological processes may produce therapeutic benefits among patients with opioid-treated chronic pain. The aim of this study was to conduct a theory-driven mechanistic analysis of proximal outcome data from a Stage 2 randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), an integrative intervention designed to promote positive psychological health. METHOD: Patients with opioid-treated chronic pain (N = 95; age = 56.8 ± 11.7; 66% female) were randomized to 8 weeks of therapist-led MORE or support group (SG) interventions. A latent positive psychological health variable comprised of positive affect, meaning in life, and self-transcendence measures was examined as a mediator of the effect of MORE on changes in pain severity at posttreatment and opioid misuse risk by 3-month follow-up. RESULTS: Participants in MORE reported significantly greater reductions in pain severity by posttreatment (p = .03) and opioid misuse risk by 3-month follow-up (p = .03) and significantly greater increases in positive psychological health (p < .001) than SG participants. Increases in positive psychological health mediated the effect of MORE on pain severity by posttreatment (p = .048), which in turn predicted decreases in opioid misuse risk by follow-up (p = .02). CONCLUSIONS: Targeting positive psychological mechanisms via MORE and other psychological interventions may reduce opioid misuse risk among chronic pain patients receiving long-term opioid therapy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A systematic review of somatic intervention treatments in PTSD: Does Somatic Experiencing® (SE®) have the potential to be a suitable choice? / Uma revisão sistemática de tratamentos de intervenção somática em PTSD: a Experiência Somática® tem o potencial para ser uma escolha adequada? / Una revisión sistemática de tratamientos de intervención somática en el trastorno de estrés postraumático: ¿tiene la experiencia somática® el potencial de ser una opción adecuada?

The psychophysiological substrate of Post-traumatic stress disorder (PTSD) is associated with deregulation of neural networks involving mind-body interaction and is the subject of considerable research. It has been managed using pharmacological treatment associated or not with complementary treatments. The aim of this study was to systematize the knowledge about the types and effectiveness of complementary treatments using somatic interventions in the PTSD setting. According to the revised literature, the complementary approaches are based on Somatic Experiencing®, meditation and brainspotting techniques, and are anchored in the search for regulating the underlying neural mechanisms. However, there is little scientific production on these treatments, despite the positive clinical impact of their results, particularly for Somatic Experiencing®, which has presented good results. For the authors, further controlled trials involving improvement of symptoms and their association with possible biological markers are necessary to corroborate the efficacy of this therapy.

O transtorno de estresse pós-traumático (TEPT),cujo substrato psicofisiológico é associado à desregulação de redes neurais que envolvem a interação mente-corpo, é objeto de muitas pesquisas e vem sendo manejado usando tratamento farmacológico associado ou não a tratamentos complementares.O objetivo desse estudo foi sistematizar o conhecimento sobre os tipos e eficácia de tratamentos complementares que utilizam intervenções somáticas no quadro do TEPT. Segundo a literatura revisada, as intervenções somáticas são baseadas em técnicas de experiência somática, meditação, brainspotting e estão ancoradas na busca da regulação dos mecanismos neurais subjacentes. Todavia, constatou-se baixa produção científica destes tratamentos, apesar do impacto clínico positivo de seus resultados, particularmente para experiência somática® que apresentou bons resultados. Para os autores, mais estudos controlados envolvendo melhora dos sintomas e sua associação a possíveis marcadores biológicos são necessários para corroborar a eficácia desta terapia.

El trastorno de estrés postraumático (TEPT), cuyo sustrato psicofisiológico está asociado a la desregulación de redes neuronal que involucran la interacción mente-cuerpo, es objeto de muchas investigaciones y viene siendo manejado usando tratamiento farmacológico asociado o no a tratamientos complementarios. El objetivo de este estudio fue sistematizar el conocimiento sobre los tipos y la eficacia de los tratamientos complementarios que utilizan intervenciones somáticas en el trastorno de estrés postraumático. De acuerdo con la literatura revisada, las intervenciones somáticas se basan en técnicas de experiencia somática, meditación, braquines y están ancladas en la búsqueda de la regulación de los mecanismos neurales subyacentes. Sin embargo, se constató baja producción científica de estos tratamientos, a pesar del impacto clínico positivo de sus resultados, particularmente para la experiencia somática®, que presentó buenos resultados. Para los autores, más ensayos controlados involucran la mejora de los síntomas y su asociación a posibles marcadores biológicos son necesarios para corroborar la eficacia de esta terapia.

Mindfulness for psychosis: a humanising therapeutic process.

Mindfulness for psychosis has been slow to develop, in part because of the fear and stigma that surrounds psychosis. Breakthrough research showing how to adapt mindfulness groups for people with current distressing psychosis has led to a growing research base and it is now clear that adapted mindfulness for psychosis is both safe and therapeutic. However, how it works is less clear. This article argues that at its heart is a core humanising therapeutic process, characterised by key metacognitive insights and increased acceptance both of psychotic experience and the self. This core therapeutic process is underpinned not only by commitment to mindfulness practice, but also through active, constructive engagement with the group process. Individuals discover that that they are more than the psychosis, and that the self is balanced (positive and negative) and changing. It is recommended that future research explores these intra-personal and inter-personal therapeutic processes alongside outcome trials.

The Therapy Process Questionnaire - Factor analysis and psychometric properties of a multidimensional self-rating scale for high-frequency monitoring of psychotherapeutic processes.

Many outcome measures and session-related questionnaires in psychotherapy are designed for weekly or biweekly administration. Yet, today, technical developments allow for higher frequency assessments to monitor human change dynamics more closely by daily assessments. For this purpose, the Therapy Process Questionnaire (TPQ) was developed, with a specific focus on inpatient psychotherapy. In this article, we present an explorative and confirmative factor analysis of the TPQ on the basis of the time series data of 150 patients collected during their hospital stay (mean time series length: 69.1 measurement points). A seven-factor solution was identified, which explains 68.7% of variance and associates 43 items onto the factors, which are "well-being and positive emotions," "relationship with fellow patients," "therapeutic relationship and clinical setting," "emotional and problem intensity," "insight/confidence/therapeutic progress," "motivation for change," and "mindfulness/self-care." The internal consistency (Cronbach's α), the inter-item correlations of the subscales, and the discriminative power of the items are excellent. The TPQ can be applied in practice and research for creating time series with equidistant measurement points and time series lengths, which are appropriate for the application of nonlinear analysis methods. Especially in clinical practice, it is important to identify precursors of phase transitions, changing synchronization patterns, and critical or instable periods of a process, which now is possible by internet- or app-based applications of this multidimensional questionnaire.

Default Mode Network, Meditation, and Age-Associated Brain Changes: What Can We Learn from the Impact of Mental Training on Well-Being as a Psychotherapeutic Approach?

Aging is a physiological process accompanied by cognitive decline, principally in memory and executive functions. Alterations in the connectivity of the default mode network (DMN) have been found to participate in cognitive decline, as well as in several neurocognitive disorders. The DMN has antisynchronic activity with attentional networks (task-positive networks (TPN)), which are critical to executive function and memory. Findings pointing to the regulation of the DMN via activation of TPN suggest that it can be used as a strategy for neuroprotection. Meditation is a noninvasive and nonpharmacological technique proven to increase meta-awareness, a cognitive ability which involves the control of both networks. In this review, we discuss the possibility of facilitating healthy aging through the regulation of networks through meditation. We propose that by practicing specific types of meditation, cognitive decline could be slowed, promoting a healthy lifestyle, which may enhance the quality of life for the elderly.

Mindfulness and progressive muscle relaxation as standardized session-introduction in individual therapy: A randomized controlled trial.

OBJECTIVE: There is scarce research on the effects of mindfulness in individual therapy. As many practitioners integrate mindfulness exercises into individual therapy, empirical evidence is of high clinical relevance. METHOD: We investigated the effects of a session-introducing intervention with mindfulness elements (SIIME) in a randomized, controlled design. The effects of SIIME on therapeutic alliance and symptomatic outcome were compared with progressive muscle relaxation (PMR) and treatment-as-usual (TAU) control conditions. The sample comprised 162 patients with anxiety and depression. RESULTS: Multilevel modeling revealed a significant symptom reduction and significant increase of alliance over the course of therapy. There were no significant time-condition interactions on outcome and alliance, indicating the comparable efficiency of all three treatment conditions. CONCLUSIONS: We found no advantage of SIIME versus PMR and TAU. Add-on mindfulness might not improve individual therapy related to alliance and outcome.

A journey through chaos and calmness: experiences of mindfulness training in patients with depressive symptoms after a recent coronary event - a qualitative diary content analysis.

BACKGROUND: Psychological distress with symptoms of depression and anxiety is common and unrecognized in patients with coronary artery disease (CAD). Efforts have been made to treat psychological distress in CAD with both conventional methods, such as antidepressant drugs and psychotherapy, and non-conventional methods, such as stress management courses. However, studies focusing on the experiences of mindfulness training in this population are still scarce. Therefore, the aim of this study was to explore immediate experiences of mindfulness practice among CAD patients with depressive symptoms. METHODS: A qualitative content analysis of diary entries, written immediately after practice sessions and continuously during an 8-week long Mindfulness Based Stress Reduction course (MBSR), was applied. RESULTS: Twelve respondents participated in the study. The main category: a journey through chaos and calmness captured the participants' concurrent experiences of challenges and rewards over time. This journey appears to reflect a progressive development culminating in the harvesting of the fruits of practice at the end of the mindfulness training. Descriptions of various challenging facets of mindfulness practice - both physical and psychological - commonly occurred during the whole course, although distressing experiences were more predominant during the first half. Furthermore, the diary entries showed a wide variety of ways of dealing with these struggles, including both constructive and less constructive strategies of facing difficult experiences. As the weeks passed, participants more frequently described an enhanced ability to concentrate, relax and deal with distractions. They also developed their capacity to observe the content of their mind and described how the practice began to yield rewards in the form of well-being and a sense of mastery. CONCLUSIONS: Introducing MBSR in the aftermath of a cardiac event, when depressive symptoms are present, is a complex and delicate challenge in clinical practice. More nuanced information about what to expect as well as the addition of motivational support and skillful guidance during the course should be given in accordance with the participants' experiences and needs. TRIAL REGISTRATION: The trial was retrospectively registered in clinicaltrials.gov (registration number: NCT03340948 ).

Two are Better Than One: Dual-Track Interventions in Hypnotherapy.

The current article provides clinical conceptualizations of six dual-track interventions for dealing with stuck and resistant situations in hypnotherapy. Dual-track interventions are based on the assumption that patients habitually regard their problems as one-dimensional and thus, tend to become rigid in their attitudes toward these problems. Dual-track interventions constitute hypnotherapeutic processes for transforming patients' negative and rigid perceptions of their problems into more positive and functional mental states that provide a dual-dimensional view, thereby offering patients more options and freeing them to contend with their problems more effectively. We introduce a novel hypnotherapeutic tool from the Illness/Nonillness Model (Navon 2014). This tool, known as the differentiation tool, can transform negative perceptions of psychological and emotional conditions to positive and hopeful perceptions.

Perspectives on Queer Music Therapy: A Qualitative Analysis of Music Therapists' Reactions to Radically Inclusive Practice.

BACKGROUND: The queer music therapy model was designed by Bain, Grzanka, and Crowe in 2016 as a novel therapeutic approach to affirm and empower LGBTQ+ identity through music. No data have been generated on how this model might actually be implemented, or the strengths and limitations of the model according to music therapy professionals. OBJECTIVE: The purpose of this study was to build on Bain and colleagues' work by collecting music therapists' perspectives on queer music therapy and using these data to critically evaluate the model. METHODS: Semi-structured qualitative interviews were conducted with twelve music therapists who identify as LGBTQ+ or have experience working with LGBTQ+ clients. Participants were prompted to discuss their music therapy backgrounds, experiences with LGBTQ+ clients, and reactions to the queer music therapy model. Interviews were analyzed using a critical discourse analysis approach. RESULTS: The qualitative findings revealed major strengths of the queer music therapy model and ways in which it could be improved by attending to: (a) the structural limitations of the music therapy discipline, including the demographic composition of the field and lack of critical perspectives in music therapy training; and (b) intersectional considerations of ageism and ableism within diverse LGBTQ+ populations. CONCLUSIONS: Queer music therapy has positive implications for future work with LGBTQ+ individuals, but it must more substantively integrate intersectionality theory to serve a diverse range of LGBTQ+ clients. Further, it must critically attend to the structural limitations of the music therapy discipline itself.

Unwanted effects of psychotropic drug interactions with medicinal products and diet supplements containing plant extracts. / Niepozadane efekty interakcji leków psychotropowych z produktami leczniczymi i suplementami diety zawierajacymi wyciagi roslinne.

OBJECTIVES: Assessment of adverse drug interactions with herbal preparations (HP), i.e., plant medicines and nutritional supplements which contain plant extracts. METHODS: Analysis of 147 cases of adverse events with clinical picture indicating probability or certainty of resulting from inclusion of HP into the applied pharmacotherapy (mostly psychotropic drugs). RESULTS: The most common effect of interactions between SSRI or SNRI antidepressants and HP were hemorrhagic complications associated with Japanese ginkgo biloba (27.45% of complications in this subgroup). Another common complication was serotonin syndrome (SS) (11.8%) occurring during the use of ginseng (one case of SS after the addition of bacopa). In the group of antipsychotic drugs, the highest number of interactions was observed in the case of haloperidol, and the highest number of complications (29.8%) was associated with ginseng (including 6 cases of ventricular arrhythmias in combination with haloperidol), milk thistle (including 7 cases of pancreatitis in combination with haloperidol or risperidone, 1 case of hepatotoxicity after adding aripiprazole) and rhodiola rosea. As for hypnotics and sedatives - interactions with ginseng were most frequently reported, mainly intensified sedative effects, cognitive disorders and disturbances in consciousness. In 132 cases, withdrawal of the plant preparation resulted in a decrease in the severity of the reported adverse reactions or a complete resolution of the described symptoms. CONCLUSIONS: HP (especially ginseng, rhadiola rosea, ginkgo biloba, milk thistle) are associated with a significant risk of pharmacokinetic and pharmacodynamic interactions with psychotropic drugs. Because of the resulting complications and side effects, any decision to include a herbal supplement should be preceded by a detailed safety analysis with benefit and risk assessment.

RIME (Relaxamento, imagens mentais, espiritualidade): psicoterapia breve por imagens alquímicas / RIME (Relaxation, mental images, spirituality): brief psychotherapy by alchemical images

Dentro da temática 'psicoterapia e espiritualidade em saúde', este artigo apresenta a Intervenção RIME (Relaxamento, Imagens Mentais e Espiritualidade) a qual foi desenvolvida e aperfeiçoada pela autora por dezoito anos, através de estudos de mestrado, doutorado e pós-doutorado, tanto em pacientes em cuidados paliativos na terminalidade, como em pacientes com possibilidades de cura. Objetivamos apresentar ao leitor a psicoterapia breve por imagens alquímicas RIME, descrevendo o passo a passo para a sua aplicação. A metodologia utilizada para o desenvolvimento da RIME, ao longo dos estudos, compreendeu a abordagem qualitativa e a quantitativa. A Intervenção RIME é uma psicoterapia breve, de caráter complementar, desenvolvida para ambiente hospitalar, que integra as técnicas de relaxamento, imaginação dirigida e elementos da espiritualidade, em uma abordagem simbólica e transpessoal. Embora tenha sido desenvolvida para ambiente hospitalar, pode ser utilizada como uma técnica adjuvante no processo psicoterapêutico clássico, no consultório, frente à determinação de um foco de trabalho. Observamos que a RIME promove a conexão com a sabedoria interna, com o Sagrado, para minimizar angústias, ressignificar a dor psíquica, a dor espiritual, ou um foco de sofrimento definido pelo paciente. Possibilita o fortalecimento dos recursos psíquicos saudáveis e da resiliência, promovendo qualidade de vida frente ao adoecer. Por ser uma psicoterapia breve pode ser aplicada por todos os profissionais da área de saúde, tanto em situação de cuidados paliativos, como em situação de possibilidades de cura

Within the theme 'psychotherapy and spirituality in health', this article presents the RIME Intervention (Relaxation, Mental Images and Spirituality) that was developed and perfected by the author for eighteen years, through master's, doctoral and postdoctoral studies, both in patients in palliatives care, in the terminal phase, as well as in patients with possibilities of cure. Our goal is introduce to the reader to the brief psychotherapy by alchemical images RIME, describing the step by step for its application. The methodological approach used for the development of RIME, throughout the studies, comprised the qualitative and the quantitative method. The RIME Intervention is a brief psychotherapy, of a complementary character, developed for a hospital environment, which integrates the techniques of relaxation, directed imagination and elements of spirituality, in a symbolic and transpersonal approach. Although it was developed for the hospital environment, it can be used as an adjuvant technique in the classic psychotherapeutic process in the clinic. It has been observed that RIME promotes the connection with the Inner Wisdom, with the Sacred, in order to minimize anguish, to re-signify psychic pain, spiritual pain, or a focus of suffering, defined by the patient. It allows strengthening the healthy psychic resources and the resilience, promoting the quality of life in the process of the disease. Because it is a brief psychotherapy, it can be applied by all health professionals, both in situations of the palliative care and in situations of healing possibilities.

El tratamiento grupal de adolescentes con trastornos graves de la personalidad: Una aproximación contextual / Group therapy for adolescents with severe personality disorders: a contextual approach

El presente trabajo se centra en los trastornos mentales graves en la adolescencia, y más específicamente en los trastornos de personalidad. La Terapia Dialéctico Conductual (DBT) es uno de los tratamientos con más evidencia para adolescentes con este tipo de trastornos. Entre las terapias contextuales, la DBT se centra en la reducción de los trastornos de conducta graves, haciendo énfasis en el entrenamiento de habilidades. La relación terapéutica es uno de los componentes clave para tratar la patología de personalidad en adolescentes. Asimismo, la combinación con otras terapias contextuales, como la Psicoterapia Analítica Funcional (PAF), permite un mayor efecto de la DBT. El objetivo de este artículo es mostrar cómo la PAF, combinada con estrategias de otras psicoterapias contextuales, supone una mejora clínica en adolescentes con trastornos de personalidad graves. En este artículo se describe la intervención clínica ambulatoria realizada con cuatro adolescentes de entre 13 y 17 años de edad, diagnosticadas de enfermedad mental grave y con criterios de trastornos de personalidad. Los principales síntomas evaluados fueron la impulsividad, los intentos de suicidio, las autolesiones, la auto y heteroagresividad, los síntomas psicóticos y los problemas del yo. El instrumento de medida utilizado fue el Inventario Clínico para Adolescentes de Millon (MACI). Tras una intervención de cuatro meses, se observó un descenso en las escalas clínicas significativas del MACI. También se encontró una mejoría en cognición, tendencias suicidas, regulación emocional y experiencia del yo (AU)

The present work focuses on severe mental disorders in adolescence; and more specifically on personality disorders. Dialectical Behavioral Therapy (DBT) has proven effective in teenagers with these disorders. Among contextual therapies, DBT aims to reduce serious behaviour disorders, emphasizing skills training. The therapeutic relationship is one of the key components of successful treatment of personality pathology in adolescents. DBT has a greater effect combined with other contextual therapies, such as Functional Analytic Psychotherapy (FAP). The purpose of this paper is to show how FAP, in combination with the latest technical advances in other contextual therapies, brings about clinical improvement in adolescents with severe personality disorders. Four teenagers, between 13 and 17 years old, diagnosed with a severe mental disorder and meeting some criteria for personality disorders, received treatment in an outpatient setting. The main symptoms evaluated were: high impulsivity, suicide attempts, self-injury, self and heteroagressivity, psychotic symptoms, and problems of the self. Patients were assessed with the Millon Adolescent Clinical Inventory (MACI). After a four-month intervention, a decrease in the MACI Clinical scales was observed. We also found an improvement in cognition, suicidal tendencies, emotional regulation, and experience of self (AU)

Predictors of premature termination from psychotherapy for anorexia nervosa: Low treatment credibility, early therapy alliance, and self-transcendence.

OBJECTIVE: Failure to complete treatment for anorexia nervosa (AN) is- common, clinically concerning but difficult to predict. This study examines whether therapy-related factors (patient-rated pretreatment credibility and early therapeutic alliance) predict subsequent premature termination of treatment (PTT) alongside self-transcendence (a previously identified clinical predictor) in women with AN. METHODS: 56 women aged 17-40 years participating in a randomized outpatient psychotherapy trial for AN. Treatment completion was defined as attending 15/20 planned sessions. Measures were the Treatment Credibility, Temperament and Character Inventory, Vanderbilt Therapeutic Alliance Scale and the Vanderbilt Psychotherapy Process Scale. Statistics were univariate tests, correlations, and logistic regression. RESULTS: Treatment credibility and certain early patient and therapist alliance/process subscales predicted PTT. Lower self-transcendence and lower early process accounted for 33% of the variance in predicting PTT. DISCUSSION: Routine assessment of treatment credibility and early process (comprehensively assessed from multiple perspectives) may help clinicians reduce PTT thereby enhancing treatment outcomes.

Integrative Treatment of Personality Disorder. Part I: Psychotherapy.

In this paper, we outline the concept of integrative therapy of borderline personality, also referred to as fragmented personality, which we consider to be the core psychopathology underlying all clinical subtypes of personality disorder. Hence, the terms borderline personality, borderline disorder, fragmented personality, and personality disorder are used interchangeably, as synonyms. Our integrative approach combines pharmacotherapy and psychotherapy, each specifically tailored to accomplish a positive feedback modulation of their respective effects. We argue that pharmacotherapy and psychotherapy of personality disorder complement each other. Pharmacological control of disruptive affects clears the stage, in some cases builds the stage, for the psychotherapeutic process to take place. In turn, psychotherapy promotes integration of personality fragments into more cohesive structures of self and identity, ultimately establishing self-regulation of mood and anxiety. We introduce our original method of psychotherapy, called reconstructive interpersonal therapy (RIT). The RIT integrates humanistic-existential and psychodynamic paradigms, and is thereby designed to accomplish a deep reconstruction of core psychopathology within the setting of high structure. We review and comment the current literature on the strategies, goals, therapy process, priorities, and phases of psychotherapy of borderline disorders, and describe in detail the fundamental principles of RIT.