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1.
Am J Clin Hypn ; 62(1-2): 12-30, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31265365

RESUMEN

To build bridges between hypnosis and contemporary psychoanalysis, this article addresses how hypnosis, when used in psychotherapy, facilitates curative action through its relational essence. The author's extensive experience with hypnosis, psychotherapy, and psychoanalysis orient the narrative toward the unconscious patient-therapist interaction, with particular attention paid to the ethics of the inherent hypnotic seduction. Whether used primarily in relief-oriented ways or geared toward more transformative therapeutic aims, powerful unconscious factors are in play for both patient and therapist and are explicated to illustrate the interactive and frequently unformulated, intersubjective factors that facilitate effective, psychotherapeutic hypnosis. Consequently, therapists attuned to such intersubjective dynamics can make use of their own internal mental activities to understand a patient's current state of mind and level of developmental functioning, and thereby subsequently formulate mutative interventions. For instance, because hypnotizability reflects the ability to play in imaginative space, the regression promoted in hypnotherapy may activate both an illusion of omnipotence and its optimal disillusionment through the relational context. This requires going beyond more traditional, procedural ways of bifurcating hypnotic interventions as being either direct or indirect and instead further distinguish hypnotic interventions in accordance with their maternal and paternal relational dimensions. Arguably, then, the skillful hypnotherapist needs to maintain a coupling interplay between the maternal, maximally receptive and the paternal, more active modes of functioning within hypnotic play space.


Asunto(s)
Hipnosis , Teoría Psicoanalítica , Humanos , Hipnosis/ética , Imaginación , Relaciones Profesional-Paciente/ética , Psicoanálisis , Alianza Terapéutica
2.
Am J Clin Hypn ; 62(1-2): 1-11, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31265366

RESUMEN

In this guest editorial, the authors introduce a special issue of the American Journal of Clinical Hypnosis that focuses on relational factors of hypnosis in psychotherapy. The authors have invited a number of esteemed colleagues to comment on aspects of the therapeutic relationship, and how it informs and influences the processes, techniques, and outcomes of hypnosis and therapy. In addition to summarizing each of these articles, this article analyzes the major relational themes that present across the articles.


Asunto(s)
Hipnosis , Humanos , Alianza Terapéutica
3.
Am J Clin Hypn ; 62(1-2): 74-94, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31265367

RESUMEN

This article explores five interwoven principles about relationship that impact on attentional focus as it relates to the practice of clinical hypnosis. It first reviews how relationship is an irreducible feature of life that greatly predates the arrival of human beings. Second, it describes brain structures that, from an evolutionary perspective, appeared relatively recently, and the neuropsychological abilities those structures confer on human relationships. Third, it links those social brain structures to trance, an inborn response to novelty that is an important feature of our adaptive learning capacity. It further suggests that narrative is a multilevel concept that is deeply embodied and constitutes the sorbate from which hypnotic interactions can draw their rich impact. Finally, the article posits that hypnosis represents a skill set through which attuned clinicians engage in co-creative dances with clients, where the choreography of their interaction attends and responds to spontaneously arising and/or deliberately seeded opportunities for adaptive change. Reconstructed descriptions of interactions with clients are provided to illustrate the application of the principles presented.


Asunto(s)
Encéfalo/fisiología , Hipnosis , Humanos , Relaciones Profesional-Paciente , Alianza Terapéutica
4.
Am J Clin Hypn ; 62(1-2): 118-137, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31265368

RESUMEN

Over the years, the field of hypnosis has often given more attention to the state and procedural factors of hypnosis than the relational ones. In an attempt to address this imbalance, the 60th annual meeting of the American Society of Clinical Hypnosis (ASCH) had as its theme "Hypnosis and the Treatment Relationship." A centerpiece of this meeting was a collegial discussion among a panel of psychologists with expertise in relational hypnotherapy. The panel addressed several pertinent questions: (1) What are the healing qualities of relationship in psychotherapy? (2) What makes hypnosis relational in nature? (3) How do relational factors of hypnosis resemble healthy attachment processes and recapitulate stalled developmental maturation? (4) How does relationally informed hypnotherapy influence and strengthen the relationship, process, and outcome of psychotherapy? This article summarizes the factors that led to the creation of this panel; provides an edited transcript of this panel discussion, along with additional commentary on several key points raised; and concludes with a summary of the main themes and recommendations for further clinical practice and study.


Asunto(s)
Hipnosis , Alianza Terapéutica , Humanos , Relaciones Profesional-Paciente , Psicoterapia
5.
Am J Clin Hypn ; 62(1-2): 31-59, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31265369

RESUMEN

This article develops the idea that hypnosis is an interactive phenomenon occurring in a relational matrix. A tripartite model for explicating this relational matrix is presented, which includes a discussion of transference, contemporary relationship factors, and the interaction of these to produce a sense of therapeutic alliance. These relationship factors are central to the therapeutic action of hypnosis as a vehicle to potentiate change and growth. The unique and specific contribution of each of these factors to the process of hypnotherapy and to therapeutic action is examined. Phenomenologically, this relational interaction is conceptualized as occurring in transitional space, shaped by processes of regression and attunement. From this perspective, the hypnotherapist is viewed as a kind of transitional object whose empathic presence contains and facilitates those interactive phenomena which evoke and balance the transferential and contemporary aspects of the relationship and which allow for uniquely evocative developmentally focused interventions in trance work. Several examples are presented from an ongoing case that demonstrate how these relational variables shape the hypnotherapeutic process and how they can be used for uncovering and self-examination, for structural maturation, for affect regulation, and for emerging ego mastery. The therapeutic action demonstrated relies on hypnotic interventions rooted in the various components of the relational matrix made possible by the clinician's awareness of and attunement to these and by hisor her informed and sensitive management of them and of his or her own intersubjectivity. Specific strategies are presented via these examples to effectively utilize this experience in the service of treatment goals.


Asunto(s)
Hipnosis , Encéfalo/fisiología , Humanos , Modelos Psicológicos , Relaciones Profesional-Paciente , Alianza Terapéutica
6.
Am J Clin Hypn ; 62(1-2): 95-117, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31265370

RESUMEN

This article explores how hypnotic strategies can be used within a polyvagal science framework to help create more secure attachment within the therapeutic relationship, as well as within the client in terms of ego-state relationships. Principles of safety and connection are emphasized, along with specific strategies to access the attachment circuits of the ventral vagal system, including the necessity of being present with the client without agenda. Uses of hypnosis related to safety and connection and methods to work with the center core self to facilitate empowerment, self-cohesion, and conflict-free experience are also reviewed. From an ego-state therapy perspective, a discussion of hypnosomatic approaches to connect with preverbal, nonverbal, and somatic aspects of self to accomplish developmental repair and facilitate secure attachment is also offered, along with case examples. A three-step model, which attempts to integrate polyvagal, somatic, and hypnotic approaches, is offered by the author to help structure corrective experiences for clients with trauma.


Asunto(s)
Ego , Hipnosis , Relaciones Profesional-Paciente , Encéfalo/fisiopatología , Humanos , Modelos Psicológicos , Apego a Objetos , Trastornos por Estrés Postraumático/fisiopatología , Trastornos por Estrés Postraumático/terapia , Alianza Terapéutica
7.
Am J Clin Hypn ; 62(1-2): 60-73, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31265372

RESUMEN

This article examines the spatial and social nature of human relationships with children and adolescents in clinical hypnosis. Beginning with the unique way in which the phenomenon of rapport is intrinsic to the therapeutic uses of hypnosis and is distinct among other therapies, the stage is set for the importance of relational hypnosis. Through the use of case vignettes that illustrate developmental imperatives, relationship factors influencing the clinical interaction are demonstrated in practice. These include transference and countertransference, safety, embodiment, novelty, creativity, respect, trust, equality, being with, loving responses, synchronicity, and empathy. Hypnotic relating exists in a framework through which absorption in play and imagination evokes the child's resources and suggestions are made. In this receptive stance the personalized suggestions lead to an environment for positive change.


Asunto(s)
Hipnosis , Imaginación , Adolescente , Niño , Desarrollo Infantil , Preescolar , Femenino , Humanos , Masculino , Relaciones Profesional-Paciente , Alianza Terapéutica
8.
Am J Clin Hypn ; 62(1-2): 138-158, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31265373

RESUMEN

It is unquestioned that reaching the hypnotic state is helped along by relational factors and that, conversely, relational experiences can be deepened through hypnosis. It is also true that deepening the experience of being in a relationship with another person is neither comfortable nor indicated for every patient or therapist. Most humans feel ambivalent about closeness. People vary in their desire for and their skill in sustaining mature intimacy. When we move along the continuum from rudimentary notions about relational factors in psychotherapy, such as rapport, to complex concepts, such as enactments, we move along a corresponding continuum of increasing need for specialized training, supervised experience, and personal therapy. The field of psychotherapy has been plagued from its inception by not knowing what to do with the tensions that emerge when two people listen to and look at each other. Avoiding relational factors may be a very human response to a very daunting matter.


Asunto(s)
Miedo , Relaciones Profesional-Paciente , Psicoterapia , Emociones , Miedo/psicología , Humanos , Hipnosis , Relaciones Interpersonales , Psicoanálisis , Alianza Terapéutica
10.
Psychiatr Danub ; 31(Suppl 3): 411-415, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31488762

RESUMEN

BACKGROUND: Based on our 2012 study and a review of the literature on the therapeutic alliance we asked ourselves different questions: does the alliance exert a real influence on the evolution of depressive affects, the rate of remission and the physical and global health? SUBJECTS AND METHODS: In a two-year study, forty people with major depressive disorder are randomly assigned to groups that receive a SSRI (escitalopram) or a SNRI (duloxetine), each group receive concomitant ASA (100 mg) or a placebo. Sociodemographic data are recorded and patients under went regular assessments with the Hamilton depression scale (HDS) and Clinical Global Impression (CGI) scale, the Helping Alliance Questionnaire (HAQ) and the Short Form Health Survey (SF-12). RESULTS: There is no significant difference in efficacy between the two antidepressants or between antidepressant treatment with and without ASA. However, subgroup comparisons reveal that the duloxetine + ASA (DASA) subgroup showed a more rapid improvement in HDS score as early as 2 months (t=-3.114, p=0.01), in CGI score at 5 months (t=-2.119, p 0.05) than the escitalopram + placebo (EP) subgroup. Regardless of the treatment arm, the remission rate at 2 years is 50%. Among patients in remission a majority, 65%, have a high level of alliance in opposition to nonresponders who have found mostly a low level of alliance (χ2=6.296, p 0.012). HAQ scores are not correlated with HAD scores, but a correlation is found with remission rates (r=0.316*). At all times, HAQ scores are correlated with physical health. CONCLUSION: Our findings suggest that a noradrenergic agent combined with ASA is more effective in treating depression than a serotonergic agent alone. A good alliance improves effectiveness of anti-depressant treatment of 1.85 and leads to an improvement of the physical health rather than directly on the depressive feelings.


Asunto(s)
Antidepresivos/uso terapéutico , Trastorno Depresivo Mayor/terapia , Estado de Salud , Inhibidores de la Captación de Serotonina/uso terapéutico , Inhibidores de Captación de Serotonina y Norepinefrina/uso terapéutico , Alianza Terapéutica , Citalopram/uso terapéutico , Método Doble Ciego , Clorhidrato de Duloxetina/uso terapéutico , Humanos
11.
Trends Psychiatry Psychother ; 41(2): 128-135, 2019 Jul 10.
Artículo en Inglés | MEDLINE | ID: mdl-31291411

RESUMEN

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.


Asunto(s)
Fibromialgia/psicología , Lupus Eritematoso Sistémico/psicología , Relaciones Profesional-Paciente , Psicoterapia Psicodinámica , Alianza Terapéutica , Anciano , Emociones , Femenino , Humanos
12.
Trends Psychiatry Psychother ; 41(2): 112-120, 2019 May 30.
Artículo en Inglés | MEDLINE | ID: mdl-31166563

RESUMEN

INTRODUCTION: Different instruments and methods for measuring factors related to the progress and effectiveness of psychodynamic psychotherapy (PDT) have been widely discussed in the literature. However, there are no established guidelines on the most appropriate time to perform these measurements. OBJECTIVES: The aim of this study is to problematize what is the appropriate time to measure the initial outcomes (symptoms, interpersonal relationships, quality, and social role) and process factors (alliance) in the early stages of PDT. METHODS: A naturalistic cohort study was conducted, following 304 patients during the first six months of psychotherapy. The therapeutic alliance was evaluated after four sessions; symptoms, interpersonal relationships, and social role were evaluated at intake and after 12 and 24 sessions. RESULTS: Our results indicate that four sessions were sufficient to measure the bond dimension of the therapeutic alliance, while more time is probably needed to adequately measure other aspects of the therapeutic alliance, such as tasks and goals. However, 12 sessions of treatment proved sufficient to detect improvements in all dimensions of the outcome instruments with moderate effect sizes, and those gains were stable at the 24th session. CONCLUSION: According to our findings, 12 sessions seem to be sufficient to assess initial gains in PDT, although more studies are needed to evaluate the appropriate time to assess all aspects of the therapeutic alliance. Further studies are also required to evaluate the appropriate time to assess intermediate and long-term progress with regard to symptoms, interpersonal relations, social role and personality reorganization.


Asunto(s)
Trastornos Mentales/terapia , Psicoterapia Psicodinámica , Alianza Terapéutica , Adulto , Femenino , Humanos , Relaciones Interpersonales , Estudios Longitudinales , Masculino , Trastornos Mentales/psicología , Personalidad , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
13.
J Consult Clin Psychol ; 87(8): 734-744, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31219276

RESUMEN

OBJECTIVE: The therapeutic alliance has long been considered an essential part of treatment. Despite a large body of work examining the alliance-outcome relationship, very few studies have examined it within individuals with first episode psychosis (FEP). METHOD: The present study examined the alliance at Session 3, 4, or 5 and its relationship to 2-year treatment outcomes and therapy participation in a sample of 144 FEP clients who received specialized FEP treatment at U.S. clinics. Furthermore, we examined between-therapist and within-therapist (client) effects of the alliance on outcomes. RESULTS: Results indicated that a better alliance was related to improved mental health recovery, psychological well-being, quality of life, total symptoms, negative symptoms, and disorganized symptoms at the end of treatment. In addition, the between-therapist effect of the alliance was significantly related to better mental health recovery whereas the within-therapist (client) effect of the alliance was related to better quality of life, total symptoms, and negative symptoms at the end of treatment. CONCLUSIONS: A stronger alliance was related to improved treatment outcomes in FEP. Future work should consider examining mediators of the alliance-outcome relationship as well as how changes in the alliance relate to changes in outcomes over time. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Trastornos Psicóticos/terapia , Calidad de Vida/psicología , Resiliencia Psicológica , Alianza Terapéutica , Adolescente , Adulto , Femenino , Humanos , Masculino , Trastornos Psicóticos/psicología , Resultado del Tratamiento , Adulto Joven
14.
J Consult Clin Psychol ; 87(7): 617-628, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31219293

RESUMEN

OBJECTIVE: The aim of this study was to identify differential baseline profiles of interpersonal problems in patients with emotional disorders and investigate their ability to predict the extent to which alliance is important for early treatment outcome in therapy. METHOD: Ninety-six patients diagnosed with emotional disorders were admitted to psychotherapy at an independent practice center. After the first session, participants completed the Inventory of Interpersonal Problems and, after each of the first four sessions, the Alliance Negotiation Scale and the Outcome Questionnaire. We characterized the interpersonal problems of the sample using the circular statistics and the structural summary methods. Based on evidence of heterogeneity between patients, we conducted cluster analysis to identify differential profiles of interpersonal problems. We tested whether the identified profiles can predict the strength of the association between alliance negotiation and early treatment outcome using hierarchical linear models. RESULTS: A two-cluster solution showed the best fit for the data. One cluster was characterized by Cold interpersonal problems (too hostile) and the other by Overly Nurturant interpersonal problems (too dependent). The identified profiles were significant predictors of the early alliance negotiation-outcome association. Overly Nurturant patients showed greater early improvements in outcome in the face of a stronger alliance negotiation. CONCLUSIONS: Results support the importance of personalized approaches using patients' interpersonal profiles to determine the importance of alliance negotiation for early treatment outcome. Findings should be replicated in randomized controlled trials using strategies to manipulate alliance negotiation. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Trastornos del Humor/terapia , Psicoterapia/métodos , Alianza Terapéutica , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Humor/psicología , Encuestas y Cuestionarios , Resultado del Tratamiento
15.
J Consult Clin Psychol ; 87(8): 745-755, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31204838

RESUMEN

OBJECTIVE: Our goal was to evaluate treatment attendance patterns, including both treatment completion and premature termination from treatment, for 2 evidence-based psychotherapies for major depressive disorder (MDD) delivered in a community mental health setting. We explored rates of premature termination across the course of treatment as well as the factors that predicted and moderated premature termination and treatment completion. METHOD: This investigation included 237 patients with MDD who participated in a noninferiority trial comparing short-term dynamic psychotherapy (DT) to cognitive therapy (CT). Patients in both conditions were offered 16 sessions of treatment and had up to 5 months to complete treatment. All patients completed an extensive self-report battery at treatment baseline as well as measures of the therapeutic alliance and opinions about treatment following Session 2. RESULTS: Premature termination from both treatments was high with 27% of patients discontinuing treatment very early after only an intake session or a single treatment session. Patients in CT were significantly more likely to terminate treatment prematurely, χ²(3) = 14.35, p = .002. Baseline physical health functioning, subthreshold psychotic symptoms, Session 2 ratings of agreement on tasks, and Session 2 ratings of treatment sensibility all independently predicted premature termination of services. Trauma history significantly moderated very early termination of treatment, χ²(3) = 10.26, p = .017, with patients with high trauma histories more likely to complete DT but terminate prematurely from CT. CONCLUSIONS: Very early termination from services was higher in CT compared with DT. Including techniques to improve engagement in both therapies and matching patients to treatment based on predictors/moderators may be effective ways to optimize treatment engagement. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Terapia Cognitivo-Conductual , Trastorno Depresivo Mayor/terapia , Salud Mental , Participación del Paciente , Psicoterapia Psicodinámica , Servicios Comunitarios de Salud Mental , Trastorno Depresivo Mayor/psicología , Femenino , Humanos , Masculino , Alianza Terapéutica
16.
J Couns Psychol ; 66(4): 508-517, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31144846

RESUMEN

Client-therapist synchrony in various channels (e.g., self-reported affect or physical movement) has been shown as a key process in the construction and development of therapeutic alliance. However, psychophysiological synchrony between clients and therapists has been understudied, with the few extant studies typically relying on single-session data, and no studies examining it within the context of emotion-focused techniques. The main aim of the current paper is to examine the role of client-therapist physiological synchrony during segments of one emotion-focused technique-namely, imagery (IM) work-in predicting therapeutic alliance, and to compare it to the role of synchrony during segments of more traditional cognitive-behavioral (CB) techniques. We conducted an open-trial study in which 31 clients with test anxiety received a 6-session protocol-based treatment. Both clients' and therapists' electrodermal activity (EDA) were continuously assessed during sessions. The physiological measures for 5 sessions each (N = 128) were used to compute client-therapist synchrony in IM and CB segments. Therapeutic alliance was assessed using the Session Alliance Inventory. Client-therapist dyads' synchrony during IM and CB segments was, on average, greater than chance. Synchrony varied mostly at the session (vs. the dyad) level. Multilevel analyses revealed that the synchrony within IM segments (but not within CB segments) was significantly associated with the therapeutic bond aspect (but not the task/goal aspects) of alliance. Physiological synchrony during emotion-focused IM is tied to the bond component of the therapeutic alliance at the session level. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Relaciones Profesional-Paciente , Psicoterapia/métodos , Alianza Terapéutica , Adulto , Conducta Cooperativa , Emociones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicofisiología , Autoinforme , Adulto Joven
17.
J Consult Clin Psychol ; 87(7): 603-616, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31070387

RESUMEN

OBJECTIVE: This study investigated therapeutic alliance (TA) trajectories, their demographic and symptomatic predictors, and associations with outcome in psychodynamic child psychotherapy. METHOD: The sample included 89 Turkish children (Mage = 6.87, SD = 2.11, 46% girls) with internalizing (37.11%), externalizing (21.14%), and comorbid (38.20%) problems; 12% of the children were in the nonclinical range. Independent raters coded 328 sessions from different phases of treatment using the Therapy Process Observational Coding System-Alliance Scale. Outcome measures were collected at intake and termination (Children's Behavior Checklist and Teacher Rating Form). RESULTS: Multilevel growth curve modeling indicated that TA showed a quadratic trend (high-low-high) over the course of treatment. The shape-of-change methodology indicated three subgroups following a stable pattern, a slow and an accelerated quadratic TA trajectory. Externalizing problems (teacher report) negatively predicted average TA strength. Boys and children with internalizing problems showed a declining TA trajectory, whereas children with externalizing problems (teacher report) showed an upward TA trajectory. Multivariate multiple regression analyses showed that the average TA (i.e., intercept) and the positive quadratic slope (the high-low-high pattern) positively predicted changes in internalizing and externalizing problems (teacher report). DISCUSSION: This study was the first to show the course of TA development in psychodynamic child psychotherapy, identify a number of child characteristics that facilitate and impede TA. Investigating both the strength and patterns of TA development when examining associations with outcome is important. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Trastornos de la Conducta Infantil/terapia , Psicoterapia Psicodinámica , Alianza Terapéutica , Niño , Trastornos de la Conducta Infantil/psicología , Preescolar , Femenino , Humanos , Masculino
18.
Int J Law Psychiatry ; 63: 68-75, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30940362

RESUMEN

Based on the recommendations of a commission set up to review the handling of Family Law cases in Israel, the Family Courts Law 5755-1995 included a revolutionary provision - that a Social Services Unit, staffed by senior social workers, would be an integral part of each Family Court. Their mandate includes giving assessment, advice and assistance services to litigants and to the court, and this provision has been broadly interpreted, to include mediation and referrals for therapy. The activities of the Unit are confidential and free of charge to the parties. More recently the Units were given the task of seeing children whose future is the subject of litigation, to find out their needs and views; and also to serve as the agency which parties who want to start proceedings are required to attend, in order to receive information about the effect of proceedings on their children and advice about alternative dispute resolution to avoid litigation. The resulting synergy between the social workers and the Judges ensures that the needs of all those involved are met in a therapeutic fashion where this is necessary and possible, alongside the judicial powers to make orders as needed. Thus unnecessary suffering can be mitigated.


Asunto(s)
Familia/psicología , Rol Judicial , Padres/psicología , Servicio Social/legislación & jurisprudencia , Servicio Social/métodos , Niño , Custodia del Niño/legislación & jurisprudencia , Confidencialidad/legislación & jurisprudencia , Disentimientos y Disputas/legislación & jurisprudencia , Divorcio/legislación & jurisprudencia , Violencia Doméstica/legislación & jurisprudencia , Femenino , Humanos , Israel , Jurisprudencia , Legislación como Asunto , Masculino , Negociación , Proyectos Piloto , Alianza Terapéutica
19.
J Consult Clin Psychol ; 87(5): 472-483, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30829505

RESUMEN

OBJECTIVE: Although a better therapeutic alliance associates with treatment outcome, it may do so in different ways. For example, alliance quality may promote improvement as it shifts over time (within-patient changes); alternatively, alliance quality may also, or instead, influence outcome when generally higher or lower for some patients relative to others (between-patient differences). Although both components have been linked to patient improvement, the distinct mechanisms of these associations have been rarely examined. Conceptually, it follows that within-patient alliance fluctuations (representing the changing nature of a current relationship intended to be ameliorative) may facilitate other interpersonal improvements that could, in turn, translate into symptom reduction. This path squares with the corrective relational experience notion. In contrast, whereas as patients' average alliances across therapy may generally facilitate or hinder improvement, the mechanism may not be other relationship functioning. This squares with the notion that when people generally experience good alliances with their therapist, it may reflect an existing relational ability that catalyzes the effectiveness of other nonrelational therapeutic means. This study tested these distinct hypotheses. METHOD: Patients (N = 85) with generalized anxiety disorder were randomly assigned to cognitive-behavioral therapy, either alone or integrated with motivational interviewing. They rated alliance quality, interpersonal problems, and outcome repeatedly. RESULTS: Using multilevel structural equation modeling, both within- and between-patient alliances related to subsequent worry reduction. As predicted, change in interpersonal problems mediated the association only at the within-patient level. CONCLUSIONS: Results contribute to the literature on mechanisms of the within- and between-person alliance-outcome association. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Trastornos de Ansiedad/terapia , Terapia Cognitivo-Conductual/métodos , Relaciones Interpersonales , Entrevista Motivacional/métodos , Alianza Terapéutica , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
20.
Int J Eat Disord ; 52(3): 278-282, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30706955

RESUMEN

OBJECTIVE: This study examined clinicians' views of the roles of two elements of cognitive behavioral therapy (CBT) in explaining treatment outcomes-CBT techniques and the therapeutic alliance. METHOD: Ninety-eight clinicians who reported delivering CBT for eating disorders completed measures addressing their beliefs about what is effective in CBT, their use of specific techniques, and their own anxiety levels. RESULTS: Clinicians substantially overestimated the role of both therapeutic techniques and the alliance in explaining treatment outcomes in CBT. Weak but significant correlations were found between therapist anxiety levels and their beliefs about the value of therapeutic techniques or the alliance. However, these associations were in different directions, with higher levels of clinician anxiety associated with more belief in the effects of the alliance but with less belief in the role of CBT techniques. Belief in the role of the therapeutic alliance was associated with a lower likelihood of encouraging the patient to change their eating pattern, while belief in the role of techniques was linked to greater use of case formulation, cognitive restructuring, behavioral experiments and body image work. DISCUSSION: Clinicians overestimate the value of both the alliance and therapy techniques in explaining treatment outcomes in CBT for eating disorders. Their beliefs about the strength of these factors are related to their own anxiety, and to their choice of techniques. Clinicians and supervisors should attend to the evidence regarding the impact of a range of elements of therapy, and work with all of those factors to enhance outcomes.


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Trastornos de Alimentación y de la Ingestión de Alimentos/terapia , Adulto , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Femenino , Humanos , Masculino , Alianza Terapéutica , Resultado del Tratamiento
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