Psychometric properties of the Brazilian Portuguese version of the Copenhagen Burnout Inventory (CBI) in healthcare professionals.

INTRODUCTION: Burnout syndrome (BS) in healthcare professionals (HCP) has been a major concern, and even more so during the coronavirus disease 2019 (COVID-19) pandemic. The need for adequate tools to assess BS is urgent. The objective of this study was to validate the Brazilian Portuguese version of the Copenhagen Burnout Inventory (CBI) in HCP. METHODS: The sample comprised 1,054 Brazilian HCP. Data were collected for 1 month (May-2020 to June-2020) using an online self-administered questionnaire. RESULTS: All three CBI dimensions demonstrated optimal reliability. All consistency measures attained values > 0.90. Split-half correlation values with Spearman-Brown reliability were higher than 0.8. The parallel analysis suggested two factors: personal burnout (PB) and work-related burnout (WB) items were associated with factor 1, and client-related burnout (CB) items were associated with factor 2. CONCLUSION: Our study corroborates the validity of the Brazilian Portuguese version of the CBI, pointing to a close relation between PB and WB in HCP. A public domain tool with evidence quality to ensure sufficient content validity can aid in burnout evaluation and encourage both expansion of the research field and accurate detection and treatment of this syndrome in Brazilian HCP.

Psychometric properties of the Brazilian Portuguese version of the Copenhagen Burnout Inventory (CBI) in healthcare professionals

Abstract Introduction Burnout syndrome (BS) in healthcare professionals (HCP) has been a major concern, and even more so during the coronavirus disease 2019 (COVID-19) pandemic. The need for adequate tools to assess BS is urgent. The objective of this study was to validate the Brazilian Portuguese version of the Copenhagen Burnout Inventory (CBI) in HCP. Methods The sample comprised 1,054 Brazilian HCP. Data were collected for 1 month (May-2020 to June-2020) using an online self-administered questionnaire. Results All three CBI dimensions demonstrated optimal reliability. All consistency measures attained values > 0.90. Split-half correlation values with Spearman-Brown reliability were higher than 0.8. The parallel analysis suggested two factors: personal burnout (PB) and work-related burnout (WB) items were associated with factor 1, and client-related burnout (CB) items were associated with factor 2. Conclusion Our study corroborates the validity of the Brazilian Portuguese version of the CBI, pointing to a close relation between PB and WB in HCP. A public domain tool with evidence quality to ensure sufficient content validity can aid in burnout evaluation and encourage both expansion of the research field and accurate detection and treatment of this syndrome in Brazilian HCP.

Reações contratransferenciais de psicoterapeutas frente a uma paciente borderline em psicoterapia: um estudo qualitativo / Countertransferential reactions of psychotherapists towards a borderline patient in psychotherapy: a qualitative study

A contratransferência (CT) é um elemento do relacionamento terapêutico que possui valor clínico, especialmente com pacientes com personalidade borderline (PB). Este estudo, qualitativo e exploratório, visou identificar os sentimentos despertados em psicoterapeutas frente a um caso de paciente com PB, buscando compreendê-los em relação às características da paciente ou da sua narrativa, bem como explorar de que forma a CT seria idealmente manejada. Oito psicoterapeutas assistiram ao vídeo de uma sessão real com paciente com PB e, após, responderam a uma entrevista. As transcrições das entrevistas foram analisadas com o método Consensual Qualitative Research (CQR). Os dados organizaram-se em relação às facetas da CT, características da paciente que mobilizam afetos, e manejo da CT. Os resultados sugerem que pacientes com PB tendem a suscitar sentimentos intensos, vinculados a sua história e seu funcionamento em situação observacional, apontando para a viabilidade do método para o estudo empírico da CT. Resultados de estudos como esse podem ser utilizados como guia para jovens terapeutas compreenderem o mundo interno dos seus pacientes. A validação empírica de hipóteses clínicas fortalece a teorização e enriquece a prática psicanalítica.(AU)

Countertransference (CT) is an element of the therapeutic relationship that has clinical value, especially with borderline personality patients (BP). This qualitative and exploratory study aimed to identify the feelings aroused in psychotherapists in the case of a BP patient, seeking to understand them in relation to the patient's characteristics or her narrative, as well as exploring how the CT would be ideally managed. Eight psychotherapists watched the video of a real session with a BP patient and responded to an interview. The interview transcripts were analyzed using the Consensual Qualitative Research (CQR) method. The data were organized in relation to the facets of the CT, characteristics of the patient that mobilize affections, and management of the CT. The results suggest that patients with BP tend to elicit intense feelings, linked to their history and functioning, in an observational situation, pointing to the feasibility of the method for the empirical study of CT. Results from studies like this one can be used as a guide for young therapists to understand the inner world of their patients. Empirical validation of clinical hypotheses strengthens theorization and enriches psychoanalytic practice.(AU)

La contratransferencia (CT) es un elemento de la relación terapéutica que tiene valor clínico, especialmente en pacientes con personalidad límite (BP). Este estudio cualitativo y exploratorio tuvo como objetivo identificar los sentimientos que despiertan los psicoterapeutas en el caso de un paciente con BP, buscando comprenderlos en relación con las características de la paciente o su narrativa, así como explorar cómo se manejaría idealmente la CT. Ocho psicoterapeutas vieron el video de una sesión real y luego respondieron a una entrevista. Las transcripciones de las entrevistas se analizaron utilizando el método de Investigación Cualitativa Consensual (CQR). Los datos se organizaron en relación a las facetas del CT, características del paciente que movilizan afectos y manejo de la CT. Los resultados sugieren que los pacientes con BP tienden a provocar sentimientos intensos, ligados a su historia y funcionamiento, en una situación de observación, lo que apunta a la viabilidad del método para el estudio empírico de la CT. Los resultados de estudios como este pueden usarse como una guía para que los terapeutas jóvenes comprendan el mundo interior de sus pacientes. La validación empírica de hipótesis clínicas fortalece la teorización y enriquece la práctica psicoanalítica.(AU)

Mental health help-seeking among Brazilian medical students: Who suffers unassisted?

INTRODUCTION: Several barriers for mental health help-seeking were identified among medical students, including minimizing mental illness. Studies examining aspects particular to those who perceive psychological impairment but do not access treatment are necessary for planning interventions. AIMS: To identify help-seeking barriers based on the students' perception about their need for treatment and psychiatric symptoms. Methods: Cross-sectional study assessing 436 Brazilian medical students (833 attending the medical school = 52.3% response rate). Data collection covered sociodemographic data, mental health, academic environment, and Beck Inventories of Depression (BDI) and Anxiety (BAI). Non-parametric tests and hierarchical logistic regression were used to compare students undergoing treatment, those willing to access treatment, and the ones reporting no need for treatment. RESULTS: Among the 382 students who completed the survey (87.6% completion rate), 38.5% (n = 147) were in treatment, and 33% (n = 126) were in need. Moderate to severe risk of alcohol abuse was observed in 45.9% (n = 50) of students reporting no need for treatment. Regression models suggested that perceiving need for treatment - whether already undergoing it or not - was associated with the severity of depressive symptoms (OR 1.14 [95% CI 1.07-1.21]), female assigned sex (OR 2.18 [95% CI 1.23-3.88]), LGBTQ+ (OR 2.47 [95% CI 1.09-5.60]) and reporting good relationship with the family (OR 0.26 [95% CI 0.08-0.83]). Models comparing students in treatment and those in need, pointed that the factors associated with lacking mental health care were age (OR 0.90 [95% CI 0.82-0.99]), perception of a heavy workload (OR 2.43 [95% CI 1.35-4.38]) and good relationship with colleagues (OR 3.51 [95% CI 1.81-6.81]). DISCUSSION: Social variables and the severity of depressive symptoms are positively associated with perceived need for treatment. Age and academic environment factors were related to help-seeking behavior among students with appropriate self-awareness. We discuss these findings' implications for planning interventions.

Psychometric Properties of the Nine-Item Problematic Internet Use Questionnaire in a Brazilian General Population Sample.

Objective: The goal of the study is to adapt and examine the psychometric properties of the Brazilian version of the nine-item Problematic Internet Use Questionnaire (PIUQ-SF-9). Methods: A convenience sample of Brazilian internet users aged between 18 and 89 years (72.7% female, mean age 38.7 years ± 13.5) was recruited online from September 2018 to July 2019 (test sample = 1,525; retest sample = 237). Participants responded to the adapted version of the PIUQ-SF-9, as well as the Center for Epidemiologic Studies-Depression Scale (CES-D-10) and sociodemographic questions. Results: A bifactor model with one general factor and three specific dimensions (obsession, neglect and control disorder) yielded the best fit indices [χ2 = 67.66, df = 15, CFI = 0.99, TLI = 0.99, RMSEA = 0.048 (0.037-0.060), RMSEA p close = 0.587 and SRMR = 0.01]. McDonald's hierarchical omega coefficient was 0.76 for the general factor and varied between 0.16 and 0.33 for the specific dimensions. The intraclass correlation coefficient was 0.73 for the general factor and varied between 0.64 and 0.72 for the specific dimensions. The MIMIC model supported the scale's construct validity as the relationship of the predictors (age, time spent online, self-perception of problematic internet use, and depression symptoms) with the PIUQ-SF-9 factors was in line with the assumptions based on the literature. Conclusion: PIUQ-SF-9 seems to be a brief and culturally validated instrument with sound psychometric properties to be used in future studies on problematic internet use in the Brazilian population.

Saúde mental dos profissionais da saúde na pandemia do coronavírus (Covid-19) / Mental health of health care professionals in the coronavirus pandemic (Covid-19)

Introdução: A pandemia do coronavírus (Covid-19) impôs desafios adicionais aos profissionais da saúde (PS), potencializando o risco de sofrimento psíquico. Objetivo: Avaliar o perfil sociodemográfico e a saúde mental de uma amostra de PS do Brasil durante a pandemia do Covid-19. Métodos: Estudo transversal online realizado durante 1 mês, entre maio e junho de 2020. Sintomas depressivos foram avaliados pelo Patient Health Questionnaire 9 (PHQ-9) e o nível de burnout pelo Copenhagen Burnout Inventory (CBI). Resultados: 1054 PS foram incluídos, sendo 34,5% médicos, 19,1% técnicos de enfermagem, 14,2% enfermeiros e 11,9% psicólogos. Mais da metade da amostra total apresentou escores ≥ 50 no domínio de burnout pessoal (PB) da CBI, indicativo de alto nível de burnout, e escores no PHQ-9 sugestivos de depressão clinicamente significativa, sendo estes índices mais elevados entre os técnicos de enfermagem (68,2% com PB ≥ 50 e 68,7% com PHQ-9 ≥ 9) e os PS da linha de frente (61,3% com PB ≥ 50 e 58% com PHQ-9 ≥ 9). Os técnicos de enfermagem apresentaram escores PB (58,4 ± 20,9) e do domínio de burnout relacionado ao trabalho (WB = 51,0 ± 21,1) superiores aos dos médicos (PB= 48,2 ± 19,9 e WB= 44,2 ± 19,1) e dos psicólogos (PB= 44,2 ± 17,4 e WB= 41,2 ± 16,7) p < 0,001. Conclusão: Os elevados níveis de burnout e depressão, mais preocupantes entre os técnicos de enfermagem, corroboram a vulnerabilidade dos PS ao sofrimento emocional no contexto do atendimento à Covid-19, demonstrando a urgência de intervenções específicas.(AU)

Introduction: The coronavirus pandemic (Covid-19) posed additional challenges to health care professionals (PS), increasing the risk of psychological distress. Objective: To evaluate the sociodemographic profile and mental health of a sample of PS in Brazil during the Covid-19 pandemic. Methods: Cross-sectional online study conducted during 1 month, between May and June 2020. Depressive symptoms were assessed by the Patient Health Questionnaire 9 (PHQ-9) and the level of burnout by the Copenhagen Burnout Inventory (CBI). Results: 1054 PS were included, being 34.5% physicians, 19.1% nursing technicians, 14.2% nurses and 11.9% psychologists. More than half of the total sample had scores ≥ 50 in the the personal burnout (PB) domain of CBI, indicative of a high level of burnout, and PHQ-9 scores suggestive of clinically significant depression, these rates being higher among nursing technicians (68.2% with BP ≥ 50 and 68.7% with PHQ-9 ≥ 9) and frontline PS (61.3% with BP ≥ 50 and 58% with PHQ-9 ≥ 9). Nursing technicians had PB scores (58.4 ± 20.9) and work-related burnout domain scores (WB = 51.0 ± 21.1) higher than those of physicians (PB = 48.2 ± 19.9 and WB = 44.2 ± 19.1) and psychologists (PB = 44.2 ± 17.4 and WB = 41.2 ± 16.7) p <0.001. Conclusion: The high levels of burnout and depression, most worrying among nursing technicians, corroborate the vulnerability of the PS to emotional suffering in the context of the Covid-19 pandemic. Specific interventions are urgent.(AU)

Introducción: La pandemia de coronavirus (Covid-19) planteó desafíos adicionales a los profesionales de la salud (PS), aumentando el riesgo de angustia psicológica. Objetivo: Evaluar el perfil sociodemográfico y la salud mental de una muestra de PS en Brasil durante la pandemia Covid-19. Métodos: Estudio transversal en línea realizado durante 1 mes, entre mayo y junio de 2020. Los síntomas depresivos fueron evaluados por el Patient Health Questionnaire 9 (PHQ-9) y el nivel de burnout por el Copenhagen Burnout Inventory (CBI). Resultados: Se incluyeron 1054 PS, siendo 34,5% médicos, 19,1% técnicos de enfermería, 14,2% enfermeras y 11,9% psicólogos. Más de la mitad de la muestra total tuvo puntajes ≥ 50 en el dominio de Burnout personal (PB) de CBI, indicativo de un alto nivel de Burnout, y puntajes PHQ-9 sugestivos de depresión clínicamente significativa, siendo estas tasas más altas entre los técnicos de enfermería (68,2% con PB ≥ 50 y 68,7% con PHQ-9 ≥ 9) y el PS de primera línea (61,3% con PB ≥ 50 y 58% con PHQ-9 ≥ 9). Los técnicos de enfermería tuvieron puntuaciones de PB (58,4 ± 20,9) y el dominio de burnout laboral (WB = 51,0 ± 21,1) superior al de los médicos (PB = 48,2 ± 19,9 y WB = 44,2 ± 19,1) y psicólogos (PB = 44,2 ± 17,4 y WB = 41,2 ± 16,7) p <0,001. Conclusión: Los altos niveles de burnout y depresión, que son más preocupantes entre los técnicos de enfermería, corroboran la vulnerabilidad del PS al sufrimiento emocional en el contexto de la atención al Covid-19, demostrando la urgencia de intervenciones específicas.(AU)

The association between reflective function and global functionality in patients with borderline personality disorder.

OBJECTIVE: To examine the association between reflective function and global functionality in borderline personality disorder (BPD) patients, controlling for symptomatology and defensive style. METHOD: Thirty-nine female inpatients were evaluated employing a sociodemographic questionnaire, the Structured Clinical Interview for Personality Disorders-II (SCID-II), the Self-Reporting Questionnaire (SRQ-20), the Reflective Functioning Questionnaire (RFQ), the Defence Style Questionnaire-40 (DSQ-40) and the Global Assessment of Functioning (GAF). RESULTS: Functionality was inversely associated with the reflective function uncertainty score (-.458; p < .01) and neurotic defences (-.335; p < .05). Symptom severity (SRQ-20) was associated with the use of immature defences (-.445; p < .01). The association between functionality and the reflective function uncertainty score remained significant, even when controlled for symptoms and defensive style (p = .002). CONCLUSION: The ability to mentalise seems to play a central and somehow independent role in BPD psychopathology.

Abordagens de Psicoterapia para Pessoas com Deficiência: Revisão da Literatura / Psychotherapy Approaches for People with Disabilities: Literature Review

RESUMO: Quinze por cento da população mundial apresenta algum tipo de deficiência. Isso pode ser caracterizado por vários tipos de condições, cada uma com sua complexidade específica. Assim sendo, esta revisão da literatura objetiva identificar recentes estudos científicos, no quinquênio 2014-2019, que descrevem cuidados psicoterapêuticos com pessoas com deficiência. Foram consultados: PubMed, EMBASE, Web of Science, PsycINFO (APA), BVS (Bireme/LILACS) e SciELO. Encontrou-se um total de 1.330 artigos. Após dois processos de seleção, 26 pesquisas corresponderam aos critérios de inclusão. A metodologia de pesquisa predominante foi ensaio clínico randomizado, seguido por estudos de caso e estudos descritivos/qualitativos. Pessoas com deficiência intelectual e/ou física, deficiência visual e/ou auditiva e autismo foram as populações mais estudadas. As técnicas comportamentais prevalecem nos estudos incluídos, com menor incidência de técnicas psicodinâmicas. A psicoterapia favorece inclusive o enfrentamento de situações adversas impostas na vida de qualquer ser humano. Pessoas com deficiência também podem apresentar necessidades psicoterápicas, uma vez que, na realidade de suas vidas, incluem complexidades além de sua deficiência. Existem fortes evidências para o uso da psicoterapia como recurso eficaz para a elaboração terapêutica de problemas relacionados à saúde, à educação e à vida social de pessoas com deficiência, independentemente do tipo de intervenção psicoterápica.

ABSTRACT: Fifteen percent of the world's population has some form of disability. This can be characterized by several types of conditions, each with its specific complexity. Thus, this literature review aims to identify recent scientific studies, in the 2014-2019 five-year period, which describe psychotherapeutic care for people with disabilities. PubMed, EMBASE, Web of Science, PsycINFO (APA), BVS (Bireme/LILACS) and SciELO were consulted. It was found a total of 1,330 articles. After two selection processes, 26 research met the inclusion criteria. The predominant research methodology was the randomized clinical trial, followed by case studies and descriptive/qualitative studies. People with intellectual and/or physical disabilities, visual and/or hearing disabilities and autism were the most studied populations. Behavioral techniques prevail in the studies included, with a lower incidence of psychodynamic techniques. Psychotherapy also favors coping with adverse situations imposed on the life of any human being. People with disabilities may also have psychotherapeutic needs, since, in the reality of their lives, they also include complexities in addition to their disability. There is strong evidence for the use of psychotherapy as an effective resource for the therapeutic elaboration of problems related to health, education and social life of people with disabilities, regardless of the type of psychotherapeutic intervention.

The Brazilian-adapted Working Alliance Inventory: preliminary report on the psychometric properties of the original and short revised versions.

INTRODUCTION: Alliance is an essential component of all psychotherapies and a consistent predictor of its outcomes. The Working Alliance Inventory (WAI) is a widely used and psychometrically sound measure of alliance. It assesses three key aspects of the construct: a) agreement on the tasks of therapy; b) agreement on the therapeutic goals; and c) development of an affective bond. OBJECTIVE: To preliminarily analyze the psychometric properties of the Brazilian version of both the original, 36-item WAI, and of the short form revised, 16-item version (WAI-SR). METHODS: The sample comprised 201 psychodynamic psychotherapy patients. Alliance assessments were made after the 4th treatment session. RESULTS: The inventory adapted to Brazilian Portuguese, in both the original and short forms, appears to be reliable and valid to measure alliance and its dimensions by clients in psychotherapy. Further studies are needed to replicate and expand the findings.

The Brazilian-adapted Working Alliance Inventory: preliminary report on the psychometric properties of the original and short revised versions

Abstract Introduction Alliance is an essential component of all psychotherapies and a consistent predictor of its outcomes. The Working Alliance Inventory (WAI) is a widely used and psychometrically sound measure of alliance. It assesses three key aspects of the construct: a) agreement on the tasks of therapy; b) agreement on the therapeutic goals; and c) development of an affective bond. Objective To preliminarily analyze the psychometric properties of the Brazilian version of both the original, 36-item WAI, and of the short form revised, 16-item version (WAI-SR). Methods The sample comprised 201 psychodynamic psychotherapy patients. Alliance assessments were made after the 4th treatment session. Results The inventory adapted to Brazilian Portuguese, in both the original and short forms, appears to be reliable and valid to measure alliance and its dimensions by clients in psychotherapy. Further studies are needed to replicate and expand the findings.

Conjugando métodos clínico e empírico no estudo de caso de interrupção precoce em psicoterapia psicanalítica / Combining clinical and empirical methods for understanding a case of premature interruption in psychoanalytic psychotherapy

O objetivo deste estudo é conjugar métodos clínico e empírico de avaliação do processo psicoterapêutico para a compreensão dos fatores associados à interrupção precoce em um caso de psicoterapia psicanalítica. Os participantes foram uma díade terapêutica. A paciente é jovem adulta, atendida em uma clínica-escola, por um período de três meses. A psicoterapeuta registrou sua impressão das sessões e sua compreensão dinâmica do caso. O método de estudo do caso foi análise sistemática por meio do Psychotherapy Process Q-Set (PQS) e do Shedler-Westen Assessment Procedure (SWAP). As sessões foram gravadas em vídeo e posteriormente codificadas com os instrumentos por avaliadores externos treinados. As características do processo indicam foco nos relacionamentos amorosos e nas situações de vida atual; a paciente trazia material significativo; tendia a concordar com as intervenções da psicoterapeuta e demonstrava se sentir entendida. A psicoterapeuta, por sua vez, mostrou empatia e adotou atitude de apoio, realizando intervenções exploratórias. A sessão 6 constituiu um momento de mudança na direção do processo. Os resultados fornecem elementos para a compreensão dos fatores relacionados com a interrupção, tais como o incremento da resistência e ambivalência por parte da paciente não devidamente abordados pela terapeuta.(AU)

This study aims to combine clinical and empirical methods of therapeutic process evaluation for understanding factors associated with premature interruption in psychoanalytic psychotherapy. The participants were a therapeutic dyad. The patient is a female young adult treated in an outpatient clinic of a psychoanalytic psychotherapy training institution. The treatment lasted three months, and the patient attended 8 sessions. The psychotherapist made records about her impressions of the sessions and about her understanding of the case dynamics. The case was analyzed systematically through the Psychotherapy Process Q-Set (PQS) and the Shedler-Westen Assessment Procedure (SWAP). Therapy sessions were videotaped and later coded by external trained raters. The general features of this process indicated that psychotherapy focused on romantic relationships and actual life situations; patient usually had brought significant materials; patient tended to agree with therapist´s interventions, and appear to feel understood by the therapist. The therapist showed empathy and adopted a supportive attitude while conducting exploratory interventions. Session 6 was a turning point in the process direction. Results provide some elements for understanding process factors related to treatment interruption such as the increase of resistance and ambivalence on the part of the patient, which were not adequately addressed by the therapist.(AU)

Countertransference, Defense Mechanisms, and Vicarious Trauma in Work With Sexual Offenders.

This study aimed to examine the associations between countertransference induced by sex offenders, defense mechanisms, and manifestations of vicarious trauma in forensic psychiatrists and psychologists. A cross-sectional study using a mixed-methods design was performed with 56 Brazilian forensic psychiatrists and psychologists from October 2016 to May 2017. Countertransference, defense mechanisms, and vicarious trauma were assessed with the Assessment of Countertransference Scale, the Defense Style Questionnaire-40, and the Trauma and Attachment Belief Scale (TABS), respectively. Qualitative data analysis based on grounded theory was also performed to explore the influence of sex-offender assessments on the experts' personal and professional lives. Positive and moderate correlations were found between feelings of indifference and the Other-Safety TABS subscale (rho .43, P < .01) and between immature defense mechanisms and TABS total score (rho .45, P < .01). Qualitative data revealed changes in the professionals' identity, worldview, and beliefs related to safety and trust. Specific maladaptive coping strategies, such as feelings of indifference and immature defenses, during the assessment of sex offenders were associated with manifestations of vicarious trauma in forensic psychiatrists and psychologists. These findings indicate the need for awareness and care about the forensic expert's mental health.

Associações entre características borderline de personalidade e empatia / Asociaciones entre características borderline de personalidad y empatía / Associations between characteristics of borderline personality and empathy

Empatia é uma habilidade interpessoal supostamente prejudicada em pessoas com características imaturas e disfuncionais de personalidade. A difusão de identidade é um conceito central da organização borderline de personalidade. Com o objetivo de verificar se há associação entre traços indicativos de difusão da identidade (instabilidade self-outros, instabilidade de objetivos e instabilidade do comportamento) e diferentes dimensões da empatia (cognitiva, afetiva, madura, imatura), foi avaliada uma amostra clínica de 194 pacientes de psicoterapia. Os resultados corroboram a hipótese de associação entre as variáveis e indicam o efeito negativo da difusão de identidade sobre a empatia, uma vez que a maior instabilidade na representação de self e outros e do comportamento dos pacientes explicam a presença de mais componentes imaturos e menos componentes maduros de empatia nestes pacientes. Os achados possuem implicações clínicas

Empathy is an interpersonal ability that is supposedly impaired in people with immature and dysfunctional personality traits. Identity diffusion is a core characteristic of borderline personality organization. In order to verify if there is an association between traits indicative of identity diffusion (self-other instability, goal instability and behavior instability) and different dimensions of empathy (cognitive, affective, mature, immature), a clinical sample of 194 psychotherapy patients was examined. The results corroborate the hypothesis of association between the variables and indicate the negative effect of the identity diffusion on the empathy, since greater instability in self-other representations and in patients' behavior explain the presence of more immature and less mature components of empathy in these patients. The findings have clinical implications

La empatía es una habilidad interpersonal supuestamente perjudicada en personas con características inmaduras y disfuncionales de personalidad. La difusión de identidad es un concepto central de la organización borderline de personalidad. Con el objetivo de verificar si hay asociación entre trazos indicativos de difusión de la identidad (inestabilidad self-otros, inestabilidad de objetivos e inestabilidad del comportamiento) y diferentes dimensiones de la empatía (cognitiva, afectiva, madura, inmadura), se evaluó una muestra clínica de 194 pacientes de psicoterapia. Los resultados corroboran la hipótesis de asociación entre las variables e indican el efecto negativo de la difusión de identidad sobre la empatía, dado que la mayor inestabilidad en la representación de uno mismo y de los demás, así como del comportamiento de los pacientes explican la presencia de componentes más inmaduros y menos maduros de empatía en estos pacientes. Los hallazgos poseen implicaciones clínicas

Interaction structures in the psychodynamic psychotherapy of a patient with chronic diseases and somatic symptoms.

OBJECTIVE: This study aimed to identify and analyze the interaction structures (ISs) (patterns of reciprocal interaction between the patient-therapist dyad) that characterize the process of a successful long-term psychodynamic psychotherapy (28 months) of a patient with chronic diseases (lupus and fibromyalgia) and somatic symptoms. METHODS: The 113 sessions were videotaped and analyzed alternately (n = 60) by independent judges using the Psychotherapy Process Q-Set. Inter-rater reliability ranged from 0.60 to 0.90, with a mean of r = 0.71 (Pearson's correlation). Through a principal component exploratory factor analysis, four ISs were identified. RESULT: The patterns of interaction between patient and therapist showed clinical validity (i.e., they were easily interpretable in the context of the case under study). The ISs were non-linear and more or less prominent across different treatment sessions and stages. Some ISs were similar to those in other studies, and others were probably unique to the present process. In addition, some ISs were independent, whereas others were interrelated over time. CONCLUSION: Process studies, such as the present one, seek to address questions about the characteristics of the interaction between patient and therapist as well as to identify particular patterns of interaction that are most prominent with a specific patient at a specific condition or time. Therefore, these studies can provide some support in establishing knowledge for clinical practice, assisting in the training of therapists, as well as in the elaboration of general guidelines for the technical management of patients with specific characteristics.

Interaction structures in the psychodynamic psychotherapy of a patient with chronic diseases and somatic symptoms / Estruturas de interação na psicoterapia psicodinâmica de uma paciente com doenças crônicas e sintomas somáticos

Abstract Objective This study aimed to identify and analyze the interaction structures (ISs) (patterns of reciprocal interaction between the patient-therapist dyad) that characterize the process of a successful long-term psychodynamic psychotherapy (28 months) of a patient with chronic diseases (lupus and fibromyalgia) and somatic symptoms. Methods The 113 sessions were videotaped and analyzed alternately (n = 60) by independent judges using the Psychotherapy Process Q-Set. Inter-rater reliability ranged from 0.60 to 0.90, with a mean of r = 0.71 (Pearson's correlation). Through a principal component exploratory factor analysis, four ISs were identified. Result The patterns of interaction between patient and therapist showed clinical validity (i.e., they were easily interpretable in the context of the case under study). The ISs were non-linear and more or less prominent across different treatment sessions and stages. Some ISs were similar to those in other studies, and others were probably unique to the present process. In addition, some ISs were independent, whereas others were interrelated over time. Conclusion Process studies, such as the present one, seek to address questions about the characteristics of the interaction between patient and therapist as well as to identify particular patterns of interaction that are most prominent with a specific patient at a specific condition or time. Therefore, these studies can provide some support in establishing knowledge for clinical practice, assisting in the training of therapists, as well as in the elaboration of general guidelines for the technical management of patients with specific characteristics.

Resumo Objetivo Este estudo objetivou identificar e analisar as estruturas de interação (interaction structures [ISs]) (padrões de interação recíproca entre a dupla paciente-terapeuta) que caracterizam o processo de uma psicoterapia psicodinâmica de longa duração (28 meses) de uma paciente com doenças crônicas (lúpus e fibromialgia) e sintomas somáticos. Métodos As 113 sessões foram filmadas e analisadas alternadamente (n = 60) por juízes independentes usando o Psychotherapy Process Q-Set. A confiabilidade entre avaliadores variou de 0.60 a 0.90, com média de r = 0.71 (correlação de Pearson). Por meio de uma análise fatorial exploratória do componente principal, foram identificadas quatro ISs. Resultados Os padrões de interação entre paciente e terapeuta mostraram validade clínica (ou seja, foram facilmente interpretáveis no contexto do caso em estudo). As ISs foram não lineares e mais ou menos proeminentes em diferentes sessões e etapas do tratamento. Algumas ISs foram semelhantes às de outros estudos, e outras provavelmente foram exclusivas do presente processo. Além disso, algumas ISs eram independentes, enquanto outras estavam inter-relacionadas ao longo do tempo. Conclusão Estudos de processo como o presente procuram abordar questões sobre as características da interação entre paciente e terapeuta, bem como identificar padrões particulares de interação que são mais proeminentes com um determinado paciente em condições ou momentos específicos. Portanto, esses estudos podem fornecer suporte ao estabelecimento de conhecimentos para a prática clínica, auxiliando na formação de terapeutas, bem como na elaboração de diretrizes gerais para o manejo técnico de pacientes com características específicas.

Brazilian Portuguese translation, cross-cultural adaptation, and apparent validation of the Trauma and Attachment Belief Scale.

OBJECTIVE: This article concerns the translation, cross-cultural adaptation, and apparent validation of the Trauma and Attachment Belief Scale (TABS), an instrument used to assess the psychological effects of traumatic life experiences and vicarious trauma. METHODS: This study involved literature review and evaluation of conceptual and item equivalences involving expert discussion groups focused on the existence and pertinence of the underlying theoretical concepts and corresponding items in a Brazilian context. Two translations and respective back-translations were performed during the evaluation of semantic equivalence, as well as an evaluation considering the referential and general equivalences between the original TABS and each version. Twenty-eight psychiatrists and psychologists completed a pretest. The final version was tested for reliability through the Cronbach's alpha and for verbal comprehension through the adapted verbal-numeric scale (ranging from 0 [I didn't understand anything] to 5 [I understood perfectly and I had no doubt]) in another 64 health professionals. RESULTS: The cross-cultural adaptation demonstrated high semantic equivalence for both the general (>95.0%) and the referential (>90.0%) meaning. The total Cronbach's alpha was 0.9173. All 84 items were maintained, and they favorably contributed to the internal consistency of the scale. The mean values of the adapted verbal-numeric scale for verbal comprehension obtained from health professionals varied from 4.2 to 4.9. CONCLUSION: The Brazilian version of the TABS demonstrated high-quality conceptual, item, and semantic equivalence with the original instrument, as well as high acceptability, internal consistency, and verbal comprehension. The scale is now available for use.

Brazilian Portuguese translation, cross-cultural adaptation, and apparent validation of the Trauma and Attachment Belief Scale / Tradução para o Português brasileiro, adaptação transcultural e validação aparente da Trauma and Attachment Belief Scale

Abstract Objective This article concerns the translation, cross-cultural adaptation, and apparent validation of the Trauma and Attachment Belief Scale (TABS), an instrument used to assess the psychological effects of traumatic life experiences and vicarious trauma. Methods This study involved literature review and evaluation of conceptual and item equivalences involving expert discussion groups focused on the existence and pertinence of the underlying theoretical concepts and corresponding items in a Brazilian context. Two translations and respective back-translations were performed during the evaluation of semantic equivalence, as well as an evaluation considering the referential and general equivalences between the original TABS and each version. Twenty-eight psychiatrists and psychologists completed a pretest. The final version was tested for reliability through the Cronbach's alpha and for verbal comprehension through the adapted verbal-numeric scale (ranging from 0 [I didn't understand anything] to 5 [I understood perfectly and I had no doubt]) in another 64 health professionals. Results The cross-cultural adaptation demonstrated high semantic equivalence for both the general (>95.0%) and the referential (>90.0%) meaning. The total Cronbach's alpha was 0.9173. All 84 items were maintained, and they favorably contributed to the internal consistency of the scale. The mean values of the adapted verbal-numeric scale for verbal comprehension obtained from health professionals varied from 4.2 to 4.9. Conclusion The Brazilian version of the TABS demonstrated high-quality conceptual, item, and semantic equivalence with the original instrument, as well as high acceptability, internal consistency, and verbal comprehension. The scale is now available for use.

Resumo Objetivo Este artigo se refere à tradução, adaptação transcultural e validação aparente da Trauma and Attachment Belief Scale (TABS), instrumento utilizado para avaliar os efeitos psicológicos das experiências de vida traumáticas e do trauma vicário. Métodos Este estudo envolveu uma revisão de literatura e avaliação da equivalência conceitual e dos itens, empregando grupos de discussão de especialistas, focando na existência e pertinência dos conceitos teóricos subjacentes e na correspondência dos itens dentro de um contexto brasileiro. Duas traduções e respectivas retrotraduções foram realizadas durante a avaliação da equivalência semântica, bem como foi feita uma avaliação considerando a equivalência referencial e geral entre a TABS original e cada versão. Vinte e oito psiquiatras e psicólogos completaram um pré-teste. A versão final foi testada para confiabilidade através do alfa de Cronbach e para compreensão verbal através de uma escala verbal-numérica adaptada [variando de 0 (Eu não entendi nada) a 5 (Eu entendi perfeitamente e não tive qualquer dúvida)] em outros 64 profissionais de saúde. Resultados A adaptação transcultural demonstrou alta equivalência semântica, tanto para o significado geral (>95,0%) quanto referencial (>90,0%). O alfa de Cronbach total foi de 0,9173. Todos os 84 itens foram mantidos e contribuíram favoravelmente para a consistência interna da escala. Os valores médios da escala verbal-numérica adaptada para a compreensão verbal obtidos dos profissionais de saúde variaram de 4,2 a 4,9. Conclusão A versão brasileira da TABS demonstrou equivalência conceitual, de itens e semântica de alta qualidade com o instrumento original, bem como elevada aceitabilidade, consistência interna e compreensão verbal. A escala está atualmente disponível para uso.