Comprehension and acceptance of the Meaning-Centered Psychotherapy with a Puerto Rican patient diagnosed with advanced cancer: A case study.

BACKGROUND: Meaning-centered psychotherapy (MCP) is a structured psychotherapeutic intervention that aims to improve existential and spiritual well-being in patients with advanced cancer. To validate it, several efficacy studies with predominantly non-Hispanic white patients have been done. Puerto Ricans residing on the island are a largely overlooked segment of the US Latinx population. They have a strong national identity and are embedded in a collectivist culture which shares the Spanish language, cultural traditions, and an emphasis on familism, a cultural factor that values the role of the family in ensuring the well-being of its members. OBJECTIVE: The purpose of this study is to present a case study focused on a Puerto Rican advanced cancer patient who underwent MCP to assess the comprehension and acceptance of the MCP intervention. METHOD: We used a mixed-methods study design that included the taking of ethnographic notes, and pre- and post-test assessments of the scores the patient received on all the measures (using validated scales). The ethnographic notes were analyzed to determine the participant's comprehension and acceptance of the MCP intervention. Content analysis was performed on the ethnographic notes by three independent coders using a deductive coding approach. Pre- and post-interview assessments were conducted to explore changes in distress, spiritual well-being, and self-perceived quality of life. RESULTS: A Latino patient with stage III cancer, low income, and low literacy skills showed low comprehension of the concepts of meaning, the finite, legacy, and moderate comprehension and acceptance of the concepts of the search for hope, purpose in life, connecting with life, courage, life's limitations, and sources of meaning. However, the patient showed high comprehension of death and dying (i.e., meaningful death). The patient showed low acceptance of death and dying concepts and high acceptance of the integration of family members into the therapy. SIGNIFICANCE OF RESULTS: Additional studies are needed to address cultural themes and to improve the comprehensibility and acceptance of the manual's content and the central MCP concepts. The findings suggest that MCP has the potential of being a feasible form of psychotherapy for Latinx patients suffering from distress, low spiritual well-being, and low self-perceived QOL.

Community Norms and Human Rights: Supervising Haitian Colleagues on Interpersonal Psychotherapy (IPT) With a Depressed and Abused Pregnant Woman.

After the 2010 Haiti earthquake, Zanmi Lasante, a local health care organization, implemented a collaborative stepped-care model to address depression in community and primary care settings in rural Haiti. Specialized community health workers, the ajans santé, collaborate with local psychologists and primary care doctors to offer home-based evaluation, support, and follow-up. The services include brief interpersonal psychotherapy (IPT) and/or medication to persons who met locally defined criteria for depression. A cross-national (Haiti-United States) expert mental health team has been overseeing the program. The present IPT supervision case of a severely depressed, physically abused, and pregnant young woman illustrates the U.S.-based supervisor's internal struggle to reconcile awareness of and respect for local norms while maintaining a human rights-based framework. It also highlights the critical role of community health workers in addressing the mental health treatment gap in regions plagued by extreme poverty and adversity.

Reflections on supervision in psychotherapy.

The aim of the author is to share his reflections on supervision as a central topic in therapists' education and training programs. The concept of supervision, its functions and effects on the training process along with the contributions of different theoretical models to its evolution are addressed. Supervision alliance, the roles of supervisor and supervisee, evaluation as a central component and the influence of socioeconomic factors are discussed. The conclusions depict the most interesting paths for development in the near future and the areas where research needs to be further conducted along with the subjects most worthy of efforts in the supervision field.

The relationship between patient object relations and the therapeutic alliance in a naturalistic psychotherapy sample.

OBJECTIVES: This study examined the relationship between patients' object relations and interpersonal process in psychotherapy. Namely, we tested the hypothesis that the quality of patients' object relations is positively associated with both patient- and therapist-rated alliance quality. DESIGN: Psychotherapy was administered naturalistically, with quantitative data collection before and during treatment. METHODS: Participants included 73 adult outpatients and 23 therapists at two mental health clinics. Using the Bell Object Relations and Reality Testing Inventory, we measured four dimensions of patients' object relations at baseline-alienation, insecure attachment, egocentricity, and social incompetence. Using the Working Alliance Inventory, we measured alliance from patient and therapist perspectives. Control variables included time, patient demographics, symptom severity, and clinic. We employed hierarchical linear modelling to analyse data with a nested structure, with 138 sessions at Level 1, 73 patients at Level 2, and 23 therapists at Level 3. RESULTS: Patient alienation and insecure attachment were associated with lower patient-rated alliance, while egocentricity was associated with higher patient-rated alliance. Patients' object relations were not significantly associated with therapist-rated alliance. On average, patients perceived the alliance more positively than their therapists, with a weak positive correlation between the alliance perspectives. CONCLUSIONS: The results suggest that object relation dimensions may be important patient characteristics for forecasting therapeutic relationship quality. They also call for more attention to differences between alliance rating perspectives. PRACTITIONER POINTS: Treatment may benefit from more attention to the quality of patients' object relations. If patients present with high levels of alienation and insecure attachment, therapists may need to pay especially close attention to the therapeutic alliance, and prudently address any ruptures in its quality. When monitoring the alliance quality, it is important to consider that patients and therapists may have different perspectives. Therapists relying solely on their own perceptions are at risk of missing alliance difficulties, and patients' object relations may be uniquely predictive of their own sense of the alliance. Therefore, it may be helpful to ask patients in session and through standardized measures for feedback on how they perceive the goals and tasks of treatment and the emotional bond with their therapist. Again, any alliance tensions could then be addressed directly as a means to maintaining engagement in the service of better outcome.

Bridging the gap between research and practice in a clinical and training network: Aigle's program.

The aim of this article is to share our experience at the Aiglé Foundation in fostering research that can conducted by (or in collaboration with) clinicians within a specific type of naturalistic setting-one that not only provides psychological services but also trains psychotherapists. After presenting the structure of Aiglé and the implementation of its scientific-practitioner philosophy, we describe some of the research that has been conducted with our network of clinicians and the benefits of connecting clinical practice and academic work. We then discuss some of the obstacles that we have encountered in conducting such studies, as well as a number of strategies that we adopted in attempting to address these challenges. We end this article by briefly describing the current state of our practice-research network, and by offering some recommendations to facilitate the conduct of research by and for clinicians.

[Informed consent in psychotherapy: conceptual and complexity in clinical practice]. / El consentimiento informado en psicoterapia: revisión conceptual y complejidad en la práctica clínica.

The objective of this literature review is to introduce the concept of informed consent. It outlines the definition of informed consent, which are the component parts and technical importance particularly in the field of psychotherapy applied to mental disorders. This review puts special emphasis on the complexity that the informed consent implies in the specific relationship as psychotherapy.

Psychotherapy research in developing countries: the case of Latin America.

This article describes the state of psychotherapy research in Latin America, a developing region, by means of its scientific production as reflected in international and Latin American publications, as well as through a survey and in-depth interviews with clinicians and researchers from the region. The Latin American publication rate is still low in international journals, which stands in contrast with the high level of publication within the region. The survey reveals an interest in research as well as a limited use of research in clinical practice, while exposing the difficulties of researching and publishing. The in-depth interviews, which cover most of the region, specify Latin America's shortcomings and obstacles to researching, as well as its facilitating factors and comparative advantages. The results are discussed within the framework of the colonizer-colonized relationship, Latin American identity, and the creative integration of developed and developing regions.

El consentimiento informado en psicoterapia: revisión conceptual y complejidad en la práctica clínica / [Informed consent in psychotherapy: conceptual and complexity in clinical practice].

The objective of this literature review is to introduce the concept of informed consent. It outlines the definition of informed consent, which are the component parts and technical importance particularly in the field of psychotherapy applied to mental disorders. This review puts special emphasis on the complexity that the informed consent implies in the specific relationship as psychotherapy.

El consentimiento informado en psicoterapia: revisión conceptual y complejidad en la práctica clínica. / [Informed consent in psychotherapy: conceptual and complexity in clinical practice].

The objective of this literature review is to introduce the concept of informed consent. It outlines the definition of informed consent, which are the component parts and technical importance particularly in the field of psychotherapy applied to mental disorders. This review puts special emphasis on the complexity that the informed consent implies in the specific relationship as psychotherapy.

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.

Transtorno do pânico / Panic disorder

Objetivos: Revisar o transtorno do pânico (TP), considerando seus aspectos clínicos, epidemiológicos, diagnósticos e etiológicos, bem como os avanços no tratamento, uma vez que o TP é uma entidade nosológica acompanhada de importante prejuízo psíquico e funcional. Método: Foi realizada uma revisão narrativa da literatura nas principais bases de dados existentes (MEDLINE, PsychINFO e SciELO) e em livros textos atualizados. Resultados: Devido à sintomatologia predominantemente física desse transtorno, os pacientes geralmente procuram vários atendimentos clínicos até que o diagnóstico seja feito. Em função desses aspectos e da sua cronicidade, o TP está associado a elevados custos econômicos. O tratamento do TP pode ser feito com psicoterapia e/ou psicofármacos. As diversas abordagens terapêuticas são apresentadas com o nível de evidência de cada recomendação. Em virtude da cronicidade e morbidade do TP, pesquisas têm se voltado para o estudo de estratégias de prevenção já na infância. Conclusões: O TP é um transtorno crônico e com baixas taxas de remissão dos sintomas em longo prazo. Sendo assim, sugere-se que sejam delineados novos estudos para tratamento precoce dos transtornos de ansiedade ou mesmo para prevenção em crianças de risco.

Objective: To review panic disorder (PD) considering its clinical, epidemiological, diagnostic, and etiologic aspects, as well as the advances in its treatment, since PD is a nosologic entity characterized by important psychiatric and functional impairment. Method: A review of the literature was carried out using the main databases available (MEDLINE, PsychINFO and SciELO) and up-to-date textbooks. Results: Due to the prevalence of physical symptoms in this disorder, patients usually have to seek clinical care for several times before the diagnosis is established. As a result of these aspects and because of its chronicity, PD is associated with high economic costs. PD treatment may include psychotherapy and/or use of psychotropic drugs. In this review, we present several different therapeutic approaches, as well as the levels of evidence of each recommendation. Due to PD chronicity and morbidity, researches have been focused on the study of strategies to prevent PD since childhood. Conclusions: PD is a chronic disorder with low long-term remission rates. Therefore, we suggest that new studies should be designed concerning the early treatment of anxiety disorders or even the prevention of this disorder in children at risk.

Por que fazer pesquisa qualitativa? / Why do qualitative research?

A abordagem qualitativa de pesquisa, inserida em um paradigma de ciência que acolhe a incerteza e a contradição, apresenta um sólido suporte para a realização de estudos que visem a uma análise em profundidade de fenômenos sociais e psicológicos que nem sempre podem ser obtidos através de instrumentos quantitativos. Essa abordagem pode ser útil para fazer face aos desafios colocados pela complexidade dos processos intersubjetivos, como é o caso da psicoterapia, em que a subjetividade, os sentimentos e as relações que se desenvolvem ao longo do estudo são importantes fatores para o processo de produção de conhecimento (AU)

Considerações em torno das atuais correntes predominantes da pesquisa em psicoterapia / Considerations on major current trends in psychotherapy research

As autoras tecem considerações em torno de duas grandes correntes predominantes na pesquisa em psicoterapia no mundo. A primeira considera que os resultados dos tratamentos relacionam-se a fatores comuns existentes em todas psicoterapias, como, por exemplo, a aliança terapêutica. Isto quer dizer que a melhora do paciente seria secundária à abordagem utilizada pelo terapeuta. A outra corrente constitui-se de grupos que defendem o ponto de vista no qual cada quadro psicopatológico exigiria uma abordagem técnica específica. Embora existam fortes evidências empíricas que dão suporte a ambas as correntes, estudos cada vez mais aprofundados e rigorosos devem ser realizados para determinar quais são os fatores relacionados à eficácia e efetividade dos processos psicoterapêuticos. No entanto, revisando a literatura nacional, constata-se uma quase total ausência de publicações nesta área, ao mesmo tempo em que se observa um crescente interesse pela pesquisa em psicoterapia com metodologia qualitativa. Este achado contrasta com o tipo de pesquisa em psicoterapia realizado em países como Estados Unidos, Canadá e alguns países da Europa, onde predomina a pesquisa quantitativa. Estes aspectos são discutidos no texto, após um breve histórico da pesquisa em psicoterapia no mundo até os dias atuais. Como comentários finais, as autoras argumentam que a investigação em psicoterapia deve objetivar a validação das teorias científicas, a abertura de novas compreensões dos fenômenos e o desenvolvimento de técnicas adaptadas à atualidade. Estas devem dar base à prática dos profissionais num constante interjogo entre subjetivo e objetivo (AU)

Masculinity and gender roles among Puerto Rican men: machismo on the U.S. mainland.

The literature on masculinity and gender roles in American life has mostly over-looked Latino men, or has stereotyped them by means of a distorted concept of machismo. A reconceptualization of masculinity and machismo among Puerto Rican men is presented, based on a multidimensional view of their historical and current sociocultural reality. Relevant clinical and social services for Puerto Rican men are discussed and directions for future research are suggested.

[The ethical challenge in psychiatry]. / El desafio ético en la psiquiatría.

UNLABELLED: The historical reasons for the importance of ethical issues in medicine are revisited. An analysis of doctor-patient relationships in psychiatry allow us to conclude that the demand of an ethical reflection in this specialty is even more imperative. Specific ethical considerations are made about some customary activities of psychiatrists such as diagnosing, pharmacological prescription and psychotherapy. 1.- DIAGNOSIS: the facts that psychiatric diagnoses are based in conventions, are undemonstratable and that the patient's familial and work life depend on them, forces a careful management. 2.-Pharmacotherapy: due to the high proportion of secondary effects of pharmacological agents used in psychiatry -some of them irreversible- and the sort of human spirit manipulation that their use implicates, their indication must be painstaking. 3.- Psychotherapy: its legitimacy is the fundamental question, since the influence that a psychotherapist may get to have over his patients could be enormous. Aiming to find the real place of "healing by the word" in medicine, some Platonic texts are surveyed.

Grupo de espera: uma nova perspectiva de triagem institucional / Preparatory group: a new perspectiva of institutional assessment

As autoras propöem um novo tipo de triagem institucional através da formaçäo de "Grupo de Espera". A experiência adquirida com tal trabalho no IPq-HCFMUSP demonstrou a utilidade desse instrumento para aperfeiçoamento do processo de triagem e para melhoria do grau de esclarecimento e mobilizaçäo dos pacientes. A relaçäo paciente-instituiçäo-terapeuta é analisa teoricamente à luz de algumas teorias psicodinâmicas