Reflexões sobre a construção de uma pesquisa qualitativa em psicoterapia on-line / Reflexiones sobre la construcción de una investigación cualitativa en psicoterapia online / Reflections on the construction of a qualitative research in online psychotherapy

RESUMO. Os serviços mediados pela internet oferecem uma diversidade de formas de conexão e interatividade e, em decorrência, surgem novas intervenções em saúde mental, exigindo pesquisas que fundamentem e avaliem tais práticas. Entretanto, os estudos na área são escassos, especialmente diretrizes que auxiliem na condução de pesquisas que envolvam as intervenções baseadas na internet. Nesse sentido, o objetivo deste artigo é indicar orientações para o desenho de pesquisas de intervenção psicológica na internet, tendo como ilustração a construção de uma pesquisa interventiva em psicoterapia on-line, qualitativa, descritiva e longitudinal. São abordados seis aspectos significativos para pesquisas em intervenção digital, incluindo contato com colaboradores, critérios de participação, alcances da pesquisa, monitoramento e avaliação das intervenções, critérios tecnológicos e aspectos éticos no campo digital. São levantados aspectos técnicos, qualitativos e de cuidados necessários para manter a qualidade dos atendimentos e das pesquisas mediadas pelas tecnologias digitais. É urgente à psicologia consolidar um campo de saber que se ocupe tanto das influências das tecnologias nas subjetividades, também, delinear estudos que avaliem com rigor científico o uso da internet para o tratamento e cuidado em saúde mental.

RESUMEN. Los servicios mediados por Internet ofrecen una diversidad de formas de conexión e interactividad y, como resultado, surgen nuevas intervenciones en salud mental, que requieren investigaciones que corroboren y evalúen dichas prácticas. Sin embargo, los estudios en el área son escasos, especialmente las directrices que ayudan a realizar investigaciones que involucran intervenciones basadas en Internet. En este sentido, el objetivo de este artículo es indicar directrices para el diseño de investigación de intervención psicológica en Internet, teniendo como ilustración la construcción de una investigación intervencionista en psicoterapia online, cualitativa, descriptiva y longitudinal. Se abordan seis aspectos significativos para la investigación en intervención digital, incluyendo el contacto con colaboradores, los criterios de participación, el alcance de la investigación, el seguimiento y evaluación de las intervenciones, los criterios tecnológicos y los aspectos éticos en el campo digital. Se plantean aspectos técnicos, cualitativos y asistenciales necesarios para mantener la calidad asistencial y la investigación mediada por las tecnologías digitales. Es urgente que la Psicología consolide un campo de conocimiento que se ocupe tanto de las influencias de las tecnologías en las subjetividades como de esbozar estudios que evalúen con rigor científico el uso de Internet para el tratamiento y cuidado en salud mental.

ABSTRACT Internet-mediated services offer a variety form of connection and interactivity, from this, new mental health interventions emerge, requiring research to validate and evaluate such practices. However, studies in the area are scarce, especially guidelines that assist in conducting research involving Internet-based interventions. The purpose of this study was to indicate guidelines for the design of psychological intervention research mediated by the Internet, based on the construction of an interventional research in online, qualitative, descriptive and longitudinal psychotherapy. Six significant aspects for digital intervention. Six significant aspects for research in digital intervention are addressed, including contact with collaborators, criteria for participation, scope of research, monitoring and evaluation of interventions, technological criteria and ethical aspects in the digital field. Technical, qualitative and care aspects necessary to maintain the quality of care and research mediated by digital technologies are raised. It is urgent for Psychology to consolidate a field of knowledge that deals with the influence of technologies on subjectivities, as well as to design studies that scientifically assess the use of the internet for treatment and care in mental health.

Pericia, efectos del terapeuta y práctica deliberada: El ciclo de la excelencia / Expertise, therapist effects and deliberate practice: The cycle of excellence

La Práctica (Clínica) Basada en la Evidencia se define como la integración de la mejor investigación disponible con la pericia clínica y las características, preferencias y cultura del paciente. Del mismo modo, la variable terapeuta empieza a mostrar su influencia decisi-va en el resultado de los tratamientos psicológicos. En este trabajo se pone el énfasis en la figura del terapeuta en el contexto del pro-grama de formación PIR de especialistas en Psicología Clínica de nuestro Sistema Nacional de Salud. Se revisan los constructos pericia, efectos del terapeuta y se presenta la Práctica Deliberada como un sistema de entrenamiento que puede ayudar a mejorar los resultados de los clínicos y sus tratamientos. Se realizan recomendaciones concretas para mejorar el modelo de supervisión durante la residencia PIR y se discuten algunas de las implicaciones y limitaciones del estado actual de la cuestión

Evidence-based (clinical) practice is the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences. Similarly, the therapist factor is beginning to show its decisive influence on the outcome of psychological treatments. This paper emphasizes the therapist factor in the context of the PIR training program of Clinical Psychology specialists within our National Health System. Expertise and therapist effects are reviewed and deliberate practice is presented as a training system that can help clinical psychologists to improve their outcomes and treatments. Specific recommendations are made to improve the supervision model during PIR training and the implications and limitations of the topic are discussed

Reliability and Validity of Ambulatory Cognitive Assessments.

Mobile technologies are increasingly used to measure cognitive function outside of traditional clinic and laboratory settings. Although ambulatory assessments of cognitive function conducted in people's natural environments offer potential advantages over traditional assessment approaches, the psychometrics of cognitive assessment procedures have been understudied. We evaluated the reliability and construct validity of ambulatory assessments of working memory and perceptual speed administered via smartphones as part of an ecological momentary assessment protocol in a diverse adult sample ( N = 219). Results indicated excellent between-person reliability (≥0.97) for average scores, and evidence of reliable within-person variability across measurement occasions (0.41-0.53). The ambulatory tasks also exhibited construct validity, as evidence by their loadings on working memory and perceptual speed factors defined by the in-lab assessments. Our findings demonstrate that averaging across brief cognitive assessments made in uncontrolled naturalistic settings provide measurements that are comparable in reliability to assessments made in controlled laboratory environments.

Journalists’occupational stress: a comparative study between reporting critical events and domestic news

Nowadays, journalism is considered a stressful occupation, not only due to the stress perceived in journalists’ daily work but also due to the critical, potentially traumatic events they report. However, research on journalists’ occupational stress in both these professional settings is still scarce. This study aims to characterize and compare occupational stress variables perceived by journalists in their daily work and in critical scenarios. Taking the Holistic Model of Occupational Stress by Nelson and Simmons (2003) as a framework, 25 Portuguese journalists, all with experience in reporting critical events, were interviewed on their perceptions of some core variables of the model: occupational stressors, distress and eustress emotional reactions, and the consequences of these experiences on their well-being. Differences among these core variables, according to the number of deployments to a critical event, were statistically analysed in order to ascertain whether repeated exposure to trauma influenced journalists’ occupational stress perceptions. The data content analysis showed that occupational stressors and emotional reactions differed across settings, while the consequences associated with journalists’ experiences were perceived as being mainly negative in both occupational contexts. Significant differences were identified in some of these variables according to the number of deployments to a critical event (p < .05). These findings may contribute to a reflection on the role of media organizations in preparing and supporting journalists in their work performance, and on the promotion of occupational health within the scope of journalists’ daily work and critical events. The article closes with considerations for future studies (AU)

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Ambulatory assessment.

Ambulatory assessment (AA) covers a wide range of assessment methods to study people in their natural environment, including self-report, observational, and biological/physiological/behavioral. AA methods minimize retrospective biases while gathering ecologically valid data from patients' everyday life in real time or near real time. Here, we report on the major characteristics of AA, and we provide examples of applications of AA in clinical psychology (a) to investigate mechanisms and dynamics of symptoms, (b) to predict the future recurrence or onset of symptoms, (c) to monitor treatment effects, (d) to predict treatment success, (e) to prevent relapse, and (f) as interventions. In addition, we present and discuss the most pressing and compelling future AA applications: technological developments (the smartphone), improved ecological validity of laboratory results by combined lab-field studies, and investigating gene-environment interactions. We conclude with a discussion of acceptability, compliance, privacy, and ethical issues.

[Design of the psychology tester based on ZigBee technology].

OBJECTIVE: To design a psychological state tester based on ZigBee wireless technology. METHODS: Through analog circuit preprocessing, the heartbeat collected by the pulse sensor will be transformed into digital signal from analog signal, and then can be processed and displayed after transported to the personal computer through the Zigbee wireless communicate units. The data will be retrieval and playback for the measurement of psychology. RESULTS: The experiments show that the device is able to acquire the pulse wave of the human body in real-time, at the same time, through the ZigBee wireless network, it can accomplish real-time, secure and reliable communications, and it also can be used in the research of testing the mental state of the individual. CONCLUSION: Through the application of the ZigBee communicate technology; the psychology tester can collect the pulse signal to reflect the individual's mental state in different conditions. So it will be applicable to a wide range of psychology measurement and other areas.

Aproximación al «esquema L» de Lacan y sus implicaciones en la clínica (parte II) / What the «schema L» consists of? (Part II)

En la segunda parte del trabajo intentamos presentar el funcionamiento global del «esquema L» y demostrar su utilidad práctica en el tratamiento analítico. En este sentido, en las relaciones sociales es el «yo» el que tiene todo el protagonismo, mientras el «sujeto» queda excluido de las mismas; de ahí que estos contactos cotidianos se muestren como la incomunicación más radical, aunque parezca lo contrario. El tratamiento que realizamos, por contra, debe escapar a esos parámetros, pues durante el mismo se procura que el «imaginario» facilite progresivamente la manifestación del «sujeto del inconsciente» en toda su dimensión, traspasando las constantes y molestas interferencias yoicas. Este procedimiento, si se realiza adecuadamente como Lacan nos enseña, permite que la «palabra plena» fluya entre paciente y analista, de modo tal que el contacto que se produzca sea de «sujeto» a «sujeto», mientras que en las relaciones sociales las conexiones se formulan en términos de «ego» y «alter ego». Para lograrlo, quién se coloque al lado del paciente debe saber que ha de ocupar el lugar de la alteridad radical, del «Otro», y no del «otro» especular (AU)

In the second part of this work we try to present the global function of the «schema L» and also to show its application in the psychoanalytical work. In this sense, it's in social relationships where the ego gets the leading role as the subject remains excluded from them, resulting in a lack of communication. The treatment we provide must scape from those parameters trying the imaginary to facilitate the unconscious subject display going through ego's interferences. To carry out this procedure properly according to Lacan's teaching lets the «true word» flows between the patient and the analyst as a «subject» to «subject» meeting, contrary to what occurs in social relations in which the connection goes from «ego» to «alter ego». To get this purpose, the analyst must take the place of a radical «Other» and not the specular «other» (AU)

Representações maternas: teóricos e possibilidades de avaliação e intervenção clínica / Maternal representations: thoretical aspects and possibilities of evaluation and clinical intervention / Representaciones maternas: aspectos teóricos y posibilidades de evaluación t intervención clínica

As representações maternas englobam expectativas, fantasias e desejos da mãe sobre o bebê, assim como os aspectos transgeracionais ligados a isso. O objetivo do presente artigo é abordar essas representações, destacando as representações da mulher sobre a sua própria mãe e sobre o bebê. Além disso, buscou-se apresentar as possibilidades de avaliação e intervenção clínica sobre essas representações, segundo a perspectiva psicanalítica. Ressalta-se que a exploração das representações maternas constitui uma importante ferramenta da clínica pais-bebê, auxiliando na melhoria da qualidade dessa relação. Em decorrência disso, tal investigação poderia ser mais utilizada tanto no contexto clínico como de pesquisa.(AU)

Maternal representations include mother's expectations, fantasies and desires about baby, as well as transgenerational aspects related to. This study aims to introduce these representations, focusing on woman's representations about the own mother and baby. It also shows possibilities of evaluation and clinical intervention about these representations, in a psychoanalytical perspective. It was highlighted the investigation of maternal representations as an important instrument of parent-infant clinic, helping to improve the quality of this relationship. Then, their investigation could be more employed not only in clinical, but also in research context.(AU)

Las representaciones maternas incluyen las expectativas, las fantasías y los deseos de la madre sobre el bebé, así como los aspectos transgeneracionales relacionados a eso. El objectivo de este trabajo es introducir esas representaciones, especialmente las representaciones de la mujer sobre la propria madre y sobre el bebé. Además, son presentadas algunas posibilidades de evaluación y intervención clínica sobre estas representaciones, según la perspectiva psicoanalítica. Cabe señalar que la investigación de las representaciones maternas es una herramienta importante en la clínica padres-bebé, ayudando a mejorar la calidad de esta relación. Entonces, suya investigación podría ser más frecuente en el contexto clínico y académico.(AU)

Representações maternas: teóricos e possibilidades de avaliação e intervenção clínica / Maternal representations: thoretical aspects and possibilities of evaluation and clinical intervention / Representaciones maternas: aspectos teóricos y posibilidades de evaluación t intervención clínica

As representações maternas englobam expectativas, fantasias e desejos da mãe sobre o bebê, assim como os aspectos transgeracionais ligados a isso. O objetivo do presente artigo é abordar essas representações, destacando as representações da mulher sobre a sua própria mãe e sobre o bebê. Além disso, buscou-se apresentar as possibilidades de avaliação e intervenção clínica sobre essas representações, segundo a perspectiva psicanalítica. Ressalta-se que a exploração das representações maternas constitui uma importante ferramenta da clínica pais-bebê, auxiliando na melhoria da qualidade dessa relação. Em decorrência disso, tal investigação poderia ser mais utilizada tanto no contexto clínico como de pesquisa.

Maternal representations include mother's expectations, fantasies and desires about baby, as well as transgenerational aspects related to. This study aims to introduce these representations, focusing on woman's representations about the own mother and baby. It also shows possibilities of evaluation and clinical intervention about these representations, in a psychoanalytical perspective. It was highlighted the investigation of maternal representations as an important instrument of parent-infant clinic, helping to improve the quality of this relationship. Then, their investigation could be more employed not only in clinical, but also in research context.

Las representaciones maternas incluyen las expectativas, las fantasías y los deseos de la madre sobre el bebé, así como los aspectos transgeneracionales relacionados a eso. El objectivo de este trabajo es introducir esas representaciones, especialmente las representaciones de la mujer sobre la propria madre y sobre el bebé. Además, son presentadas algunas posibilidades de evaluación y intervención clínica sobre estas representaciones, según la perspectiva psicoanalítica. Cabe señalar que la investigación de las representaciones maternas es una herramienta importante en la clínica padres-bebé, ayudando a mejorar la calidad de esta relación. Entonces, suya investigación podría ser más frecuente en el contexto clínico y académico.

The factor structure of the MMPI-2 Restructured Clinical (RC) scales.

We investigated the MMPI-2 Restructured Clinical (RC) scales (Tellegen et al., 2003) to determine if they had a more differentiated factor structure than the MMPI-2 Clinical scales. When factored alone, the RC scales had a 5-dimensional structure; the Clinical scales had 3 dimensions. When factored in combination with the Content scales, both sets of scales produced 5 dimensions. However, the RC and Content factors generally provided more efficient and logical markers of psychopathology than the Clinical and Content factors. We discuss interpretive considerations.

Externalizing pathology and the five-factor model: a meta-analysis of personality traits associated with antisocial personality disorder, substance use disorder, and their co-occurrence.

In this meta-analysis we examined Five-Factor Model of personality (FFM) characteristics of externalizing disorders. Two pathologies, Antisocial Personality Disorder (APD) and Substance Use Disorder (SUD), have significant levels of co-occurrence that may be due to shared personality traits. Results from 63 samples (N = 15,331) were analyzed in order to summarize and compare five-factor results for APD, SUD, and co-occurring APD/SUD. Shared and unique personality features were identified at both the domain and the facet level of the FFM. Moderation analyses indicated that sample source (clinical versus community) and diagnosis (psychopathy versus DSM-based APD) accounted for some of the variability at the domain level. Results are discussed with respect to personality and externalizing disorders.

Personality and psychopathology: mapping the MMPI-2 Restructured Clinical (RC) Scales onto the Five Factor Model of personality.

The MMPI-2 Restructured Clinical (RC) Scales (Tellegen et al., 2003) reflect a recent shift for this instrument toward the measurement of contemporary conceptualizations of psychopathology. The current investigation aimed to replicate and extend the theoretical and empirical linkage between the RC scales and dimensional models of personality and to investigate how well the RC scales conform to a higher-order structure of psychopathology. Participants were 271 psychiatric patients who had been administered the MMPI-2 and revised NEO Personality Inventory (Costa & McCrae, 1992) as part of a routine psychological evaluation. The results indicated that the RC scales map onto the Five Factor Model of personality as hypothesized and in congruence with previous findings in personality and psychopathology. The RC scales conformed to a higher-order structure of internalizing, externalizing, and thought disturbance, replicating and extending previous work concerning hierarchical structures of psychopathology.

Ecological momentary assessment.

Assessment in clinical psychology typically relies on global retrospective self-reports collected at research or clinic visits, which are limited by recall bias and are not well suited to address how behavior changes over time and across contexts. Ecological momentary assessment (EMA) involves repeated sampling of subjects' current behaviors and experiences in real time, in subjects' natural environments. EMA aims to minimize recall bias, maximize ecological validity, and allow study of microprocesses that influence behavior in real-world contexts. EMA studies assess particular events in subjects' lives or assess subjects at periodic intervals, often by random time sampling, using technologies ranging from written diaries and telephones to electronic diaries and physiological sensors. We discuss the rationale for EMA, EMA designs, methodological and practical issues, and comparisons of EMA and recall data. EMA holds unique promise to advance the science and practice of clinical psychology by shedding light on the dynamics of behavior in real-world settings.

The MMPI-2 Clinical Scales and Restructured Clinical (RC) Scales: comparative psychometric properties and relative diagnostic efficiency in young adults.

We examined the psychometric properties of the Restructured Clinical (RC) scales (Tellegen et al., 2003) of the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) in a large sample (N = 744) of 18-year-old college freshman. We found that the RC scales demonstrated good convergence with their Clinical scale counterparts and were more distinctive than the Clinical scales. The patterns of discriminant correlations for the RC scales were slightly clearer than those of the Clinical scales and a set of other existing MMPI-2 scales. Diagnostic efficiency statistics based on Clinical and RC scale elevation status did not differ appreciably. However, the diagnostic efficiency statistics of cutoff scores derived from mean RC and Clinical scale T scores improved on the traditional scale elevation measures. We consider the clinical implications of these findings.

The trials of separating bath water from baby: a review and critique of the MMPI-2 Restructured Clinical Scales.

I review the development of the new set of MMPI-2 scales, the Restructured Clinical (RC) Scales (Tellegen et al., 2003). I identify several conceptual and methodological flaws in the construction of these scales, and I discuss the influence of a central shortcoming, the use of an atypical and depressively biased marker for unwanted ("first-factor") variance and its consequences for the RC Scales. I criticize the monograph introducing and describing the development of these scales for multiple important omissions. I provide examples of RC Scales in which relevant variances were overextracted or underextracted in the process of their construction. I introduce and apply the concept of "construct drift" to the RC Scales corresponding to the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) Clinical Scales, Psychasthenia and Hypomania. I conclude that the RC Scales are highly redundant with and function as routinely scored Content scales and that their designation as Clinical Scales is at best tenuous. I present two more appropriate, unbiased markers for the first factor along with the description of several nonintrusive strategies for increasing the independence of the Clinical Scales without compromising their syndromal fidelity.

The MMPI-2 Restructured Clinical Scales: a paradigmatic shift in scale development.

Tellegen et al. (2003) proposed fundamental changes in MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) scale development by discarding empirical scale development in favor of construct validation via Jackson's (1970) sequential system of scale development. As a result of their efforts, a general distress factor (Demoralization) was identified and 8 Restructured Clinical (RC) Scales were developed. Using 7,330 clinical cases from Caldwell's (1997) data set, in this study, we sought to cross-validate the MMPI-2 RC Scales. Scale homogeneity was confirmed with high alpha coefficients and interitem correlations in the expected range. We also achieved a major objective of reducing interscale correlations. In replicating Tellegen et al.'s principal components analysis, we achieved a high concordance for 6 of the 8 RC Scales. We critically examine these results in light of Jackson's construct validation. We discuss the clinical usefulness of the MMPI-2 RC Scales within the context of current and future research.

Further evidence on the validity of the MMPI-2 Restructured Clinical (RC) Scales: addressing questions raised by Rogers, Sewell, Harrison, and Jordan and Nichols.

The reviews by Rogers, Sewell, Harrison, and Jordan (2006/this issue), and by Nichols (2006/this issue) offer markedly contrasting appraisals of the MMPI-2 Restructured Clinical (RC) Scales introduced by Tellegen et al. (2003). The one common feature is that both reviews draw on the same atypical MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) data set for their empirical analyses, with results warranting critical scrutiny. Rogers et al.'s critique provides an evaluation of the RC Scales from the perspective of Jackson's (1970) method of test development. One significant issue in Rogers et al.'s review concerns social desirability, prompting us to clarify our own views on this topic. We also highlight and discuss problems associated with Rogers et al.'s use of the unrepresentative data set. Nichols's polemical critique neglects empirical and theoretical support for demoralization as a central construct and misconstrues as "construct drift" the purposeful process of developing the RC scales. Nichols's criticisms and proposals overlook requirements for assessing syndromes and for construct validation and even rudiments of scale development. Our reply incorporates evidence, including new findings, refuting his criticisms and confirming that demoralization is a pervasive MMPI dimension, that the RC Scales capture the major distinctive features of the original Clinical Scales, and that they generate correspondingly meaningful validity patterns.

MMPI-2 at the crossroads: aging technology or radical retrofitting?

Paradigmatic shifts are uncommon in psychological assessment, which is often steeped more in tradition than innovative practices. The introduction of the Restructured Clinical (RC) Scales by Tellegen et al. (2003) represents a radical shift in the development and validation of the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). In broadening the debate over the merit of the RC Scales, in this article, we examine current challenges to MMPI-2 interpretation including issues with discriminant validity and imprecision (e.g., standard errors of measurement). We evaluate the RC alternative in the context of these interpretive challenges. Although we note several improvements, the incremental validity for MMPI-2 interpretative statements remains to be established. MMPI-2 researchers may wish to test several innovative models for their comparative strengths in establishing scale properties and providing empirically based interpretations.