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1.
South Med J ; 113(4): 198-200, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32239233

RESUMO

Munchausen syndrome is a factitious disorder that is difficult to diagnose and treat. This article clarifies points for clinical recognition and management of patients with this condition. Patients with this condition often are dramatic and provide false and/or exaggerated symptoms or information. They solicit attention from physicians, going doctor-to-doctor, having repeated diagnostic tests, procedures, hospitalizations, and evidence little improvement. Adherence to treatment plans is generally suboptimal and the patients frequently leave the hospital against medical advice. A compassionate, multidisciplinary approach to treatment is advised. It often includes conjoint clinical communication between the primary care physician and a psychiatrist. Open, supportive discussion with the patient about his or her condition is important. Long-term psychotherapy and follow-up are recommended.


Assuntos
Síndrome de Munchausen/diagnóstico , Síndrome de Munchausen/psicologia , Gerenciamento Clínico , Humanos , Síndrome de Munchausen/epidemiologia , Processos Psicoterapêuticos
3.
Am J Psychoanal ; 79(4): 484-493, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31636400

RESUMO

Psychoanalysis is a narrative activity of a very special kind. One could even say that the method of free association is a subversive activity since its purpose is to cut through layers of previous conditioning in the effort to open new spaces in the psyche. The hypercathexis of neurotic functioning can only be transformed if new, unknown dynamics are able to emerge, and can then be invested by the subject. This process necessitates economic change-investing novel psychic functioning. Aided by personal analytic experience, the psychoanalyst's role is to help initiate and support this subversive activity in the patient by initiating him/her into the method of free association. Difficulties arise when neither the patient, nor the analyst are comfortable with the symbolic and metaphorical dynamics of free association. Reacting to Freud's lack of interest in an emotional analytic process with the patient, Ferenczi considered the analytical space as a mutual frame, to be transformed in and by the intimate psychoanalytical process. The author explores Ferenczi's Clinical Diary as the construction of an intimate space through narration, attempting to discover Ferenczi's techniques in this subversive activity.


Assuntos
Psicanálise/história , Terapia Psicanalítica/métodos , Processos Psicoterapêuticos , Aliança Terapêutica , História do Século XX , Humanos , Narração , Transferência Psicológica
4.
J Consult Clin Psychol ; 87(10): 927-940, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31556669

RESUMO

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).


Assuntos
Dor Crônica/terapia , Atenção Plena , Grupos de Autoajuda , Adulto , Afeto , Idoso , Analgesia/psicologia , Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Dor Crônica/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/psicologia , Transtornos Relacionados ao Uso de Opioides/terapia , Processos Psicoterapêuticos , Resultado do Tratamento
6.
Clin Psychol Psychother ; 26(5): 586-602, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31153157

RESUMO

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.


Assuntos
Transtornos Mentais/terapia , Processos Psicoterapêuticos , Autorrelato , Inquéritos e Questionários/estatística & dados numéricos , Adulto , Análise Fatorial , Feminino , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes
7.
Psychotherapy (Chic) ; 56(2): 285-296, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31144852

RESUMO

Different forms of psychotherapy are effective for cluster C personality disorders, but we know less about what in-session processes promote change. Contrasting successful and unsuccessful cases may elucidate processes that facilitate or impede outcome and offer suggestions for clinical practice and future research. In this exploratory outcome-process study, 10 successful and 10 unsuccessful cases were selected from a randomized trial comparing cognitive therapy and short-term psychodynamic psychotherapy for cluster C personality disorders. Videotaped sessions were rated with the Psychotherapy Process Q-Set (PQS). The treatments were compared in terms of which PQS items differentiated successful and unsuccessful cases, as well as their resemblance with PQS prototypes of "ideal treatments." Therapists' behavior in early sessions was also explored. Results indicate that successful cases in our sample were characterized by a more active and engaged patient. In contrast, unsuccessful cases were characterized by a more directive or "controlling" therapist stance. Correlations with PQS prototypes were moderate to strong in both successful and unsuccessful cases, suggesting that optimal and suboptimal interpersonal processes may be independent of adherence to particular treatments. Exploration of therapist behaviors in early sessions indicated that therapists were more likely to adjust their way of working in the successful cases. Our result suggests that patient engagement and therapists' early efforts to improve the therapy relationship may be pivotal for successful outcome, whereas therapist controlling behavior may obstruct the treatment process, regardless of therapy model used. The impact of these in-session processes should be examined more closely in larger samples in future studies. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtornos da Personalidade/psicologia , Transtornos da Personalidade/terapia , Processos Psicoterapêuticos , Psicoterapia Breve/métodos , Psicoterapia Psicodinâmica/métodos , Adulto , Feminino , Humanos , Masculino , Psicoterapia/métodos , Resultado do Tratamento
8.
Schmerz ; 33(4): 329-332, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31037342

RESUMO

A patient with long-term fibromyalgia syndrome and concomitant post-traumatic stress disorder is reported. The relocation to a so-called external safe site resulted within a very short time in a sustained remission of the fibromyalgia syndrome, due to psychotherapeutic interventions. This shows that-according to the clinical guidelines-a psychiatric examination and, if necessary, targeted therapy of the psychiatric comorbidity is indispensable in patients with fibromyalgia syndrome.


Assuntos
Fibromialgia , Dor , Transtornos de Estresse Pós-Traumáticos , Comorbidade , Fibromialgia/complicações , Humanos , Dor/diagnóstico , Manejo da Dor/psicologia , Processos Psicoterapêuticos , Transtornos de Estresse Pós-Traumáticos/complicações
9.
Res Aging ; 41(8): 772-793, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31043126

RESUMO

We experimentally investigated gratitude's impact on loneliness and health in older adults. Participants were assigned to a daily gratitude writing exercise (treatment group) or a control group. Self-reported loneliness and health (i.e., subjective well-being, subjective health, health symptoms) were measured daily over a 3-week period. In support of our hypotheses, within-person variability in gratitude predicted differences in loneliness and health. Furthermore, those in the treatment group showed stronger cumulative effects of gratitude on loneliness and health symptoms when aggregated across the 20-day study. Additionally, a series of conditional, multilevel indirect effect models found that loneliness acted as a mechanism for gratitude's differential impact on subjective well-being and health symptoms across conditions. Taken together, this study provides initial evidence that a simple gratitude exercise can strengthen associations among daily gratitude and loneliness and, consequently, improve health, for older adults.


Assuntos
Atividades Cotidianas , Solidão/psicologia , Redação , Idoso , Feminino , Promoção da Saúde , Humanos , Vida Independente , Estudos Longitudinais , Masculino , Processos Psicoterapêuticos , Distribuição Aleatória , Comportamento Social
10.
Neural Plast ; 2019: 7067592, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31065259

RESUMO

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.


Assuntos
Encéfalo/fisiologia , Envelhecimento Saudável/fisiologia , Envelhecimento Saudável/psicologia , Meditação , Processos Psicoterapêuticos , Atenção/fisiologia , Disfunção Cognitiva/prevenção & controle , Humanos , Metacognição , Atenção Plena , Vias Neurais/fisiologia
11.
Nervenarzt ; 90(7): 690-694, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31073672

RESUMO

BACKGROUND: Mental health professionals use various strategies to prevent involuntarily committed persons from absconding under an open door policy. OBJECTIVE: To provide an ethical framework for the evaluation of the replacement of locked ward doors by formal coercion or treatment pressures. METHODS: Empirically informed conceptual and ethical analysis. RESULTS: The replacement of locked ward doors by formal coercive measures applied to individual persons, such as mechanical restraint or seclusion, is ethically problematic. The use of treatment pressures, for example in the context of intensified observational measures, requires a differentiated ethical evaluation and does not necessarily constitute the milder means in comparison to locked ward doors. CONCLUSION: Unexplored conceptual, empirical and ethical issues surrounding open door policies and treatment pressures should be clarified by means of psychiatric and ethical research. In clinical practice, the choice of the least burdensome and least restrictive measures for involuntarily committed persons should be facilitated by appropriate ethical support services.


Assuntos
Coerção , Transtornos Mentais/terapia , Processos Psicoterapêuticos , Isolamento de Pacientes/ética , Isolamento de Pacientes/legislação & jurisprudência , Psiquiatria/ética , Psiquiatria/normas
12.
Nervenarzt ; 90(7): 724-732, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31073674

RESUMO

BACKGROUND: Implementation of the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD). The idea of human rights developed during the era of the Enlightenment. This idea has been publicly discussed since the French Revolution of 1789 and its specification has been demanded politically. Important steps in this process were the General Declaration of Human Rights adopted by the UN in 1948 and the CRPD from 2006, which was especially relevant for psychiatric actions. Meanwhile, the idea of human rights has influenced the legislation in many countries and has thus become normatively binding, e. g. in the Basic Law of Germany, in the regulations for patient care and in the professional rules for physicians. AIM AND QUESTIONS: To sensitize for reflection on one's own actions and to gain a critical distance from the general overall opinion. Then not only the global validity of the CRPD is frequently violated, as in crisis regions but also in the everyday routine when, for example, the workload prevents psychiatric personnel from taking time for essential conversations with psychiatric patients in order to support their self-determination. MATERIAL AND METHODS: These aspects are illustrated and explained with the aid of multifarious examples from the relevant literature and from own experience. RESULTS AND DISCUSSION: Human rights are a regulative idea that provide a framework and direction for psychiatric actions; however, as an idea they compete with other ideas that try to control the trends of the day (the Zeitgeist) that determine daily practice. Not only the suppression of human rights from public consciousness, e. g. with the eugenics in the first third of the previous century but also their absolutization and poor implementation, as in the Italian psychiatry reform of 1978, damage psychiatric patients. Therefore, it appears necessary to sensitize psychiatrists to reflect on the Zeitgeist and its influence on their own actions and to recognize that their own opinions and actions can also influence the Zeitgeist.


Assuntos
Direitos Humanos , Processos Psicoterapêuticos , Pessoas com Deficiência/legislação & jurisprudência , Pessoas com Deficiência/psicologia , Alemanha , Direitos Humanos/tendências , Humanos , Itália , Nações Unidas
13.
Am J Psychother ; 72(2): 38-46, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30945559

RESUMO

As a complement to multicultural competence, the multicultural orientation (MCO) perspective has been proposed as a pragmatic way to enhance cultural understandings about psychotherapeutic dynamics, processes, and outcomes. Consisting of three core components-cultural humility, cultural comfort, and cultural opportunities-the MCO is considered relevant for both individual and group treatment. However, the MCO perspective has yet to be specifically applied to psychotherapy supervision. Because supervision often provides multicultural oversight for individual and group psychotherapy services, considering the ramifications of MCO for psychotherapy supervision (MCO-S) is important. In this article, the implications of MCO-S are reviewed, with attention given to the impacts of cultural humility, cultural comfort, and cultural opportunities on the supervisor-supervisee relationship. Case examples are provided to illustrate the ways in which MCO can affect the psychotherapy supervision process and outcome. Supervision research possibilities are also proposed.


Assuntos
Competência Cultural , Psicoterapia/métodos , Diversidade Cultural , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Índios Norte-Americanos/psicologia , Masculino , Processos Psicoterapêuticos , Psicoterapia de Grupo/métodos , Adulto Jovem
14.
J Consult Clin Psychol ; 87(5): 446-456, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30998047

RESUMO

OBJECTIVE: Although cognitive change has long been posited to drive symptom improvements in cognitive therapy (CT) of depression, whether it does so remains controversial. Methodological challenges have contributed heavily to the lack of resolution on this issue. Using a patient-reported measure of cognitive change, we tested the role of cognitive change in contributing to symptom change in CT. In addition, we tested whether therapists' use of cognitive methods intended to promote cognitive changes predicted these changes. We also tested the specificity of the relation of cognitive methods and cognitive change by examining other psychotherapy process variables. METHOD: In a sample of 126 patients who participated in CT of depression, patients rated immediate cognitive change (CC-Immediate) at the end of each session and sustained cognitive change (CC-Sustained) at the start of each subsequent session. Observers rated therapist adherence and alliance for the first five sessions. Depressive symptoms were assessed at each session. For all predictors, we disaggregated within- and between-patient effects. RESULTS: Focusing on within-patient predictors, CC-Sustained mediated the relation of CC-Immediate and subsequent symptom change. In addition, both CC-Immediate and CC-Sustained predicted symptom change. Therapist adherence to cognitive methods was the only within-patient variable to predict CC-Immediate. CONCLUSIONS: These findings are consistent with the view that cognitive change contributes to symptom reductions in CT, and that therapists' use of cognitive methods contributes to cognitive changes during sessions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde , Processos Psicoterapêuticos , Adolescente , Adulto , Idoso , Terapia Cognitivo-Comportamental/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
15.
J Consult Clin Psychol ; 87(5): 484-490, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30998049

RESUMO

OBJECTIVE: Despite a growing body of research supporting the efficacy of cognitive-behavioral therapy (CBT) for depressed adolescents, few studies have investigated the role of the acquisition and use of CBT skills in accounting for symptom improvement. The present study examined the role of cognitive versus behavioral skills in predicting symptom improvement in depressed youth. Analyses considered different raters of patient skills (patient vs. therapist) as well as disaggregated between-patient versus within-patient effects. METHOD: Data were derived from a 12-week clinical trial of CBT for depressed adolescent females (N = 33; ages 13-18 years; 69.7% White). Both therapist-report and patient-report measures of CBT skills (skills of cognitive therapy) were acquired at 5 time points throughout therapy: Sessions 1, 3, 6, 9, and 12. Depressive symptoms (Beck Depression Inventory-II) were assessed at every session. RESULTS: Therapist and patient ratings of CBT skills showed small to moderate associations (rs = .20-.38). Intraclass correlation coefficients indicated that the majority of the variance in skills scores (61-90%) was attributable to within-patient variance from session to session, rather than due to between-patient differences. When disaggregating within-patient and between-patient effects, and consistent with a causal relationship, within-patient variability in both patient-rated (b = -2.55; p = .025) and therapist-rated (b = -2.41; p = .033) behavioral skills predicted subsequent symptom change. CONCLUSIONS: Analyses highlight the importance of the acquisition and use of behavioral skills in CBT for depressed adolescents. Findings also underscore the importance of disentangling within-patient from between-patient effects in future studies, an approach infrequently used in process-outcome research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Comportamento do Adolescente , Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde , Processos Psicoterapêuticos , Adolescente , Feminino , Humanos
16.
J Appl Res Intellect Disabil ; 32(4): 792-805, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30687987

RESUMO

BACKGROUND: Emerging evidence indicates effectiveness of dialectical behaviour therapy (DBT) for people with intellectual disabilities (PWID) in forensic settings; however, little is known about "what works" facilitating engagement and change. METHODS: Eleven interviews were conducted with nine service users across two secure inpatient services. Grounded theory was used to develop a model of perceived engagement and change. RESULTS: The model provides insights into how change occurs during DBT delivered in forensic settings. DBT constitutes a challenging journey, yet provides the motivation and means to address individual's intra-/interpersonal aggression and progress towards release. Participants experienced engaging with DBT as difficult and coercive, moving from compliance and avoidance to acceptance and change. Key factors included participants' motivation, beliefs about safety and ability to change, and interactions with staff. CONCLUSION: Recommendations are made for increasing intrinsic motivation, reducing perceived coercion and distress, and for future research to address potential aversive elements and enhance effectiveness.


Assuntos
Terapia do Comportamento Dialético , Deficiência Intelectual/reabilitação , Deficiências da Aprendizagem/reabilitação , Pessoas com Deficiência Mental/reabilitação , Processos Psicoterapêuticos , Adulto , Inglaterra , Feminino , Psiquiatria Legal , Teoria Fundamentada , Humanos , Deficiência Intelectual/psicologia , Deficiências da Aprendizagem/psicologia , Masculino , Pessoas com Deficiência Mental/psicologia , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto Jovem
17.
Psychotherapy (Chic) ; 56(1): 11-15, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30688483

RESUMO

As the conceptualization of evidence-based practice expands beyond the phasic application of treatment manuals for specific mental health diagnoses, greater attention is being paid to treatment personalization, including at its very first steps. One approach to such early personalization involves therapist flexible responsivity to patients' presenting nondiagnostic characteristics, such as their treatment-related beliefs, that are known to correlate with treatment outcomes. Such tailoring represents one element of the context-responsive psychotherapy integration framework that privileges the therapist's use of evidence-informed strategies in response to specific patient characteristics and contextual process markers (Constantino, Boswell, Bernecker, & Castonguay, 2013). In this article, we map context-responsive psychotherapy integration principles onto a psychotherapy case illustration. Namely, we describe Alice E. Coyne's attempt to navigate responsively a patient's early outcome expectation and treatment credibility perception, both of which revealed the need to change course from an original treatment plan (despite that plan making good sense vis-à-vis the patient's diagnoses and initial positive reaction to the explanation of a specific treatment protocol). In addition, the case illustrates the influence that patient treatment beliefs can have on other early therapeutic processes, such as patient change ambivalence and resistance to the therapy, that also require therapist responsivity in the service of personalization. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Atitude do Pessoal de Saúde , Transtornos Mentais/terapia , Relações Profissional-Paciente , Processos Psicoterapêuticos , Prática Clínica Baseada em Evidências , Humanos , Masculino , Pessoa de Meia-Idade
18.
Psychother Res ; 29(1): 30-44, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29130400

RESUMO

BACKGROUND: Emotional processing (EP) is hypothesized to be a key mechanism of change in psychotherapy that may enhance its long-term efficacy. To study the effects of fostering EP in psychotherapy for depression, this randomized-controlled clinical trial compares the efficacy and pattern of change of a cognitive-behavioral therapy that integrates emotion-focused techniques within an exposure framework (Exposure-Based Cognitive Therapy for depression; EBCT-R) to a standard cognitive-behavioral therapy (CBT). METHODS: One hundred and forty-nine depressed outpatients were randomized to a maximum of 22 sessions of manualized EBCT-R (N = 77) or CBT (N = 72). Primary outcomes were self-reported and clinician-rated depressive symptoms at posttreatment and 12-month follow-up. Secondary outcomes were self-esteem, interpersonal problems, and avoidance thoughts and behaviors. RESULTS: Depressive symptoms improved significantly over therapy in both treatments, with large within-group effect sizes for CBT (d = -1.95) and EBCT-R (d = -1.77). The pattern of depression change during treatment did not differ between treatments. Symptom relief lasted over 12 months and did not differ between EBCT-R and CBT. CONCLUSIONS: Results suggest that both treatments produced significant short- and long-term improvement in depression symptoms, but the integration of emotion-focused techniques within an exposure framework did not have added benefit. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01012856 Clinical or methodological significance of this article: This trial compares cognitive-behavioral therapy (CBT) with a similarly structured CBT that was designed to foster emotional processing by integrating emotion-focused techniques within an exposure framework. Results indicate that this form of assimilative integration did not improve outcomes at 12-month follow-up.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Depressão/terapia , Transtorno Depressivo/terapia , Emoções/fisiologia , Terapia Implosiva/métodos , Avaliação de Resultados em Cuidados de Saúde , Processos Psicoterapêuticos , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade
19.
Clin Psychol Psychother ; 26(2): 167-174, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30303262

RESUMO

Case formulation is considered important in both the development of the therapeutic relationship and in starting the process of therapeutic change. Cognitive analytic therapy (CAT) describes the developmental origins and maintenance of a client's problems in both written (reformulation letter) and diagrammatic form (sequential diagrammatic reformulation). This study aimed to investigate the effects of these reformulation tools on insight and symptom change. A small-N repeated measures design was employed with quantitative and qualitative measures collected from six therapist/client dyads. Participating therapists kept a record of their delivery of CAT reformulation tools. Participating clients completed the insight subscale of the Self-Reflection and Insight Scale every fourth session and the Clinical Outcomes in Routine Evaluation-10 every session. Qualitative data from client change interviews regarding their experiences of CAT and attributions of change was explored using template analysis. Participants demonstrated improvements (symptom reduction and insight increases) over the course of the intervention. Administration of reformulation tools did not consistently result in significant changes on insight and symptom measures. However, the tools were identified by participants as leading to insight and emotional change within the context of a good therapeutic relationship. These findings suggest that a genuine therapeutic relationship is an important change mechanism operating through, and strengthened by, CAT-specific tools.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtornos Mentais/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde/métodos , Relações Profissional-Paciente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Processos Psicoterapêuticos
20.
J Clin Psychol ; 75(1): 66-78, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30216437

RESUMO

OBJECTIVE: The aim of this study was to investigate associations between patients' subjective agency, their observable in-session behavior, and the patient-therapist interaction during the early phase of psychotherapy. METHODS: The sample included 52 depressed patients in psychodynamic psychotherapy. After Session 5, the patients' agency and the quality of the therapeutic alliance were assessed. Based on session recordings, two independent observers rated the patients' involvement, their interpersonal behavior, and the therapists' directiveness. RESULTS: Higher agency was associated with stronger therapeutic alliances. Patients who indicated higher agency in their therapy participated more actively in the session and showed less hostile impact messages. Patients' agency was not related to therapists' directiveness. CONCLUSIONS: Patients' sense of agency in psychotherapy was associated with more active involvement and affiliative interaction. The findings support the idea that patients need to feel capable of acting within and having an influence on their therapy to benefit from it.


Assuntos
Transtorno Depressivo/terapia , Relações Profissional-Paciente , Processos Psicoterapêuticos , Psicoterapia Psicodinâmica , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos em Cuidados de Saúde
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