ABSTRACT
The primary aim of this study is to improve our understanding of therapists' experience of a "difficult patient" and consider the different variables involved in this label. What makes a patient be perceived as difficult by a therapist in public health services? Results of our analysis of 10 qualitative semistructured interviews of therapists working in public health service in Chile indicated that therapists' perceptions of a "difficult patient" depend on variables that go beyond the patient's intrinsic characteristics, including patients' negative attitude toward the therapist and treating team, patients' negative effects on therapists, and a difficult treatment context (e.g., work overload, scarce resources, limited number, and frequency of sessions). We illustrate the interaction of these dimensions and focus on the impact of the treating context on therapists' experience of a "difficult patient" through the case of a therapist working with a patient with complex depression in the public health system of Chile.
Subject(s)
Depressive Disorder/therapy , Professional-Patient Relations , Psychotherapy , Adult , Chile , Humans , National Health Programs , Qualitative ResearchABSTRACT
The present study examined predictors of discrepancies between mothers', fathers', and teachers' ratings of 3-year-old children's hyperactivity, attention problems, and aggression. Participants were families of 196 3-year-old children who took part in child and family assessments. Ethnicity was one of the most consistent predictors of discrepancies. African American mothers and fathers were more likely to rate their children's hyperactivity, attention problems, and aggression lower than teachers. In contrast, Latina mothers were more likely to rate their children as more hyperactive and inattentive than teachers. ADHD/ODD diagnoses, parental depression, number of children, and children's pre-academic skills were also predictive of discrepancies for some measures for some informants. These findings provide insight into factors that may contribute to informant discrepancies in ratings of preschool children.
Subject(s)
Borderline Personality Disorder/therapy , Personality Assessment/statistics & numerical data , Psychoanalytic Therapy , Adult , Behavior Therapy , Borderline Personality Disorder/diagnosis , Borderline Personality Disorder/psychology , Female , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Psychometrics , Psychotherapy , Reproducibility of ResultsABSTRACT
El trabajo está dividido en tres partes. La primera hace un breve recorrido histórico de la supervisión. La segunda parte relata la experiencia personal de supervisión de 4 profesionales y su supervisora abordando algunas diferencias con su aprendizaje previo basado en un modelo neo-kleiniano. Las vivencias personales recorren las expectativas, dudas y angustias producidas por cada modelo y dan vida a través del relato a conceptos centrales del modelo relacional tales como: la emergencia de significado, la co-construcción, momentos de ruptura y reparación, el enactment y la develación además de la importancia del timing y el sostén por parte de la supervisora cuando existe un impasse en la díada de la supervisión. En la tercera parte se describe una situación de impasse entre la supervisora y una de las profesionales. Como sucede en la terapia analítica, dicho impasse ha sido transmitido por vías no verbales y ha involucrado a ambas, supervisora y supervisada. Vemos que en la resolución de dicho impasse, ha sido necesario tener cuidado de mantener el sostén necesario hasta el momento adecuado para poder abordarlo. Se finaliza con algunos comentarios que insertan la experiencia en un contexto de cambio social.
The experience of supervising and being supervised in a relational model setting is described by four psychologists and their supervisor, and compared to their previous training based on a neo-kleinian model. Their journey covers the expectations, doubts and anxieties produced in each period of their learning process and gives life to key concepts in the relational model such as: co-construction of meaning, rupture and repair, enactment and disclosure, as well as the importance of timing and holding during moments of impasse. The paper is divided into three parts. The first is a brief history of supervision. The second describes the experience of the supervisees and the supervisor past and present. The third analyzes a year long impasse involving one of the supervisees and the supervisor, in which timing and holding have been necessary until a better moment is found to disclose verbally what has been experienced in the body and through non verbal means. Concluding comments insert the experience of this supervision in a context of social change.