Héctor Fernández-Álvarez (1944-2023).

This article memorializes Héctor Fernández-Álvarez (1944-2023). Héctor was an exceptional mentor, therapist, supervisor, professor, researcher, author, and leader, as well as a beloved brother, partner, father, and grandfather. The consummate renaissance person who embraced all manners of cultural expressions through an intentional wanderlust, he sought to understand all forms of human suffering and to alleviate senseless ones. Héctor's career spanned well over 5 decades. He received a licenciatura degree in 1967 from the University of Buenos Aires and a PhD in 1995 from the National University of San Luis, Argentina. Héctor held multiple academic appointments throughout Latin America and Spain. He authored over 100 journal articles or book chapters, and 16 books, including a novel, La Distancia (The Distance), and Fundamentals of an Integrated Model of Psychotherapy, one of the most respected psychotherapy books in Latin America and Spain. In 1977, Héctor challenged the constraints of a military dictatorship by founding Aiglé (the everlasting flame). Aiglé remains a nongovernmental organization that delivers clinical and community services and prepares mental health practitioners informed by an active research program that evaluates training and psychotherapeutic processes and outcomes. Over the years, Héctor advanced Aiglé as a practice-oriented research clinical setting to investigate psychotherapy as it unfolds in clinical practice. He developed an integrative model of care that resulted in Aiglé's cognitive-integrative model. Aiglé has grown to be a hallmark for research-based, leading-edge psychotherapy training in Latin America. Highlights of Héctor's career and professional contributions are noted. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Role of psychological background in cancer susceptibility genetic testing distress: It is not only about a positive result.

Clinical and familial factors predict psychological distress after genetic testing for cancer susceptibility. However, the contribution of an individual's psychological background to such distress is unclear. This study aims to analyze the psychological impact of genetic testing and to identify the profile of individuals at higher risk. This is a longitudinal multicenter study of individuals undergoing genetic testing for cancer susceptibility. Demographic, clinical, genetic, familial, and psychological (personality types, cancer worry) characteristics were assessed by validated questionnaires the day of genetic testing. Distress, uncertainty, and positive experience perception (MICRA scale) were evaluated at the results disclosure visit, and 3 and 12 months afterwards. Multivariate analysis was performed. A total of 714 individuals were included. A high neuroticism score, high baseline cancer worry, and a positive genetic test result were independently associated with higher psychological impact (p-value < 0.05). The highest risk profile (10% of the cohort) included women with high level of neuroticism and a positive result. Uncertainty was mainly associated with a high level of neuroticism, regardless of the genetic test result. A holistic approach to personalized germline genetic counseling should include the assessment of personality dimensions.

Patients' and professionals' perspective of non-in-person visits in hereditary cancer: predictors and impact of the COVID-19 pandemic.

PURPOSE: To identify predictors of patient acceptance of non-in-person cancer genetic visits before and after the COVID-19 pandemic and assess the preferences of health-care professionals. METHODS: Prospective multicenter cohort study (N = 578, 1 February 2018-20 April 2019) and recontacted during the COVID-19 lockdown in April 2020. Health-care professionals participated in May 2020. Association of personality traits and clinical factors with acceptance was assessed with multivariate analysis. RESULTS: Before COVID-19, videoconference was more accepted than telephone-based visits (28% vs. 16% pretest, 30% vs. 19% post-test). Predictors for telephone visits were age (pretest, odds ratio [OR] 10-year increment = 0.79; post-test OR 10Y = 0.78); disclosure of panel testing (OR = 0.60), positive results (OR = 0.52), low conscientiousness group (OR = 2.87), and post-test level of uncertainty (OR = 0.93). Predictors for videoconference were age (pretest, OR 10Y = 0.73; post-test, OR 10Y = 0.75), educational level (pretest: OR = 1.61), low neuroticism (pretest, OR = 1.72), and post-test level of uncertainty (OR = 0.96). Patients' reported acceptance for non-in-person visits after COVID-19 increased to 92% for the pretest and 85% for the post-test. Health-care professionals only preferred non-in-person visits for disclosure of negative results (83%). CONCLUSION: These new delivery models need to recognize challenges associated with age and the psychological characteristics of the population and embrace health-care professionals' preferences.

Psychometric properties of the Spanish version of the Clinical Outcomes in Routine Evaluation - Outcome Measure.

OBJECTIVE: The objective of this paper is to assess the reliability and validity of the Spanish translation of the Clinical Outcomes in Routine Evaluation - Outcome Measure, a 34-item self-report questionnaire that measures the client's status in the domains of Subjective well-being, Problems/Symptoms, Life functioning, and Risk. METHOD: Six hundred and forty-four adult participants were included in two samples: the clinical sample (n=192) from different mental health and primary care centers; and the nonclinical sample (n=452), which included a student and a community sample. RESULTS: The questionnaire showed good acceptability and internal consistency, appropriate test-retest reliability, and acceptable convergent validity. Strong differentiation between clinical and nonclinical samples was found. As expected, the Risk domain had different characteristics than other domains, but all findings were comparable with the UK referential data. Cutoff scores were calculated for clinical significant change assessment. CONCLUSION: The Spanish version of the Clinical Outcomes in Routine Evaluation - Outcome Measure showed acceptable psychometric properties, providing support for using the questionnaire for monitoring the progress of Spanish-speaking psychotherapy clients.

Presentación de una guía para la observación y clasificación de la conducta verbal de los Terapeutas / Presentation of an observation and classification guide of therapists' verbal behavior

El artículo presenta una guía de observación y clasificación de la conducta verbal de los terapeutas, la Guía de Observación de Terapeutas Aiglé (GOTA-v). Se revisan los estudios sobre la variable del terapeuta, especialmente el Estilo Personal y sus procedimientos de evaluación. Este nuevo instrumento fue aplicado a la transcripción de 44 sesiones de 12 terapeutas de Argentina con diferente orientación teórico-técnica y distinto grado de experiencia (bajo, medio y alto). Se delimitaron los textos de las sesiones en unidades de análisis y se clasificaron esas unidades con categorías pertenecientes a tres clases de actos de habla: Preguntas, afirmaciones e indicaciones. Se calculó el índice de acuerdo inter jueces de Kappa para cada clase. Se discuten los alcances y limitaciones del instrumento y sus posibilidades para la investigación en psicoterapia.

The article presents an observation and classification guide of therapists' verbal behavior, the Aiglé Therapists Observation Guide (ATOG-v). Studies on the therapist variables together with the assessment procedures are revisited. This new instrument was applied to the transcription of 44 sessions of 12 therapists in Argentina with different theoretical-technical orientation and different levels of experience (low, moderate and high). The session texts were delimited into analysis units and these units were classified with categories pertaining three types of speech acts: questions, statements and indications. The Kappa inter-judges index was applied for each class. The scope and limitations of the instrument and its possibilities for psychotherapy research are presented.

Efficacy of a dilemma-focused intervention for unipolar depression: study protocol for a multicenter randomized controlled trial.

BACKGROUND: Depression is one of the more severe and serious health problems because of its morbidity, disabling effects and for its societal and economic burden. Despite the variety of existing pharmacological and psychological treatments, most of the cases evolve with only partial remission, relapse and recurrence.Cognitive models have contributed significantly to the understanding of unipolar depression and its psychological treatment. However, success is only partial and many authors affirm the need to improve those models and also the treatment programs derived from them. One of the issues that requires further elaboration is the difficulty these patients experience in responding to treatment and in maintaining therapeutic gains across time without relapse or recurrence. Our research group has been working on the notion of cognitive conflict viewed as personal dilemmas according to personal construct theory. We use a novel method for identifying those conflicts using the repertory grid technique (RGT). Preliminary results with depressive patients show that about 90% of them have one or more of those conflicts. This fact might explain the blockage and the difficult progress of these patients, especially the more severe and/or chronic. These results justify the need for specific interventions focused on the resolution of these internal conflicts. This study aims to empirically test the hypothesis that an intervention focused on the dilemma(s) specifically detected for each patient will enhance the efficacy of cognitive behavioral therapy (CBT) for depression. DESIGN: A therapy manual for a dilemma-focused intervention will be tested using a randomized clinical trial by comparing the outcome of two treatment conditions: combined group CBT (eight, 2-hour weekly sessions) plus individual dilemma-focused therapy (eight, 1-hour weekly sessions) and CBT alone (eight, 2-hour group weekly sessions plus eight, 1-hour individual weekly sessions). METHOD: Participants are patients aged over 18 years meeting diagnostic criteria for major depressive disorder or dysthymic disorder, with a score of 19 or above on the Beck depression inventory, second edition (BDI-II) and presenting at least one cognitive conflict (implicative dilemma or dilemmatic construct) as assessed using the RGT. The BDI-II is the primary outcome measure, collected at baseline, at the end of therapy, and at 3- and 12-month follow-up; other secondary measures are also used. DISCUSSION: We expect that adding a dilemma-focused intervention to CBT will increase the efficacy of one of the more prestigious therapies for depression, thus resulting in a significant contribution to the psychological treatment of depression. TRIAL REGISTRATION: ISRCTN92443999; ClinicalTrials.gov Identifier: NCT01542957.

Características psicométricas de la versión española del Working Alliance Inventory-Short (WAI-S) / Psychometric propierties of Spanish versión of Working Alliance Inventory-Short (WAI-S)

Este artículo presenta un estudio de las características psicométricas de la versión española del Inventario de Alianza Terapéutica formato corto (WAI-S). La muestra la formaron 229 sujetos mayores de edad que recibieron tratamiento psicoterapéutico en un centro privado. La edad media de los participantes fue de 29.2 (SD= 8.84). Todos los participantes contestaron la versión española para pacientes del WAI-S al finalizar la tercera sesión de terapia El análisis factorial de ejes principales indicó que el primer factor está formado especialmente por los reactivos de la subescala tareas y vínculo, mientras que el segundo factor está formado por reactivos de las subescalas de objetivos y tareas. Es posible diferenciar entre las subescalas de la alianza terapeutica a nivel teórico, pero los datos indican que los reactivos de las subescalas de objetivos, tareas y vinculo positivo estan muy asociados. La estimación del coeficiente de fiabilidad basada en la consistencia interna de la versión española del WAIS se demostró buena. Los resultados sugieren que la alianza terapéutica puede ser un constructo más unificado (AU)

This paper presents a study of the psychometric properties of the Spanish short version of the Working Alliance Inventory. Method: 229 subjects received psychotherapy treatment in a private centre. The mean ages were 29.2 years old (SD=8.84). All patients answered the spanish version of the Working Alliance Inventory when they finished the third session of the therapy. The factor analysis indicated that the first factor is based by the items from the Tasks and Bonds subscale, whereas the second factor is based by the items from the Tasks and Goals subscale. It is possible to differentiate between the therapeutic alliance subscales in the theory level, but data show that items from Goals, Tasks and Bond are close related. Reliability coefficient based on the internal consistency of the spanish version of the Working Alliance Inventory (short version) is good. Results suggest that therapeutic alliance may be a more unified construct than is usually thought of (AU)

Predictors of therapeutic outcome and process.

This article presents an intensive study of the outcome and process of the psychotherapeutic treatments conducted at the Blanquerna Psychotherapy Service in Barcelona. It analyzes in detail the relation between outcome (improvement) and process (therapeutic alliance). Specifically, it discusses (a) the therapeutic process in terms of the relation between therapeutic alliance and psychotherapy outcome and (b) the effects of the temporary weakening of the therapeutic alliance and temporary symptomatic relapse on therapeutic outcome and process. Two hundred thirty-nine clients were included in the study, and the assessment instruments were the CORE Outcome Measure and the short version of the Working Alliance Inventory. In addition to good outcome of psychotherapy and maintenance of therapeutic change after treatment, the results also demonstrated the significance of different aspects of the therapeutic alliance as predictors of the therapeutic outcome and process.

Psychometric properties of the Spanish version of the Working Alliance Theory of Change Inventory (WATOCI) / Características psicométricas de la versión española del inventario de la alianza terapéutica y teoría del cambio

This Brief Report presents a study of the psychometric qualities of the Working Alliance Theory of Change Inventory (Spanish version). WATOCI’s reliability coefficient based on the internal consistency is good. Results seem to suggest (a) that the theoretical structure of the instrument should be further refined, and (b) that therapeutic alliance may be a more unified construct than is usually thought of. While it is theoretically possible to divide it into different components, clinical research with psychotherapy patients seems to indicate that goals, tasks, bond and theory of change are closely related (AU)

Este artículo presenta un estudio de las características psicométricas de la versión española del Inventario de Alianza Terapéutica y Teoría del Cambio (WATOCI). La estimación del coeficiente de fiabilidad basada en la consistencia interna de la versión española del WATOCI se demostró buena. Los resultados parecen sugerir: (a) que la estructura teorica del instrumento debe ser revisada y refinada a fondo, y (b) que la alianza terapéutica puede ser un constructo más unificado. Teóricamente es posible diferenciar entre las subescalas de la alianza terapéutica, pero los datos indican que los ítems de las subescalas de objetivos, tareas, vínculo positivo y teoría del cambio están muy asociados (AU)

La alianza terapéutica: historia, investigación y evaluación / Therapeutic alliance: history, research and assessment

La psicoterapia no se puede concebir al margen del establecimiento de una relación interpersonal entre cliente y terapeuta. Entre los componentes de la relación terapéutica, la alianza es el que ha recibido más atención por parte de la investigación. En este artículo se describen brevemente algunas de las aportaciones más significativas de las principales orientaciones teóricas en cuanto a la visión de la alianza terapéutica y se revisan las investigaciones principales que han tenido a la alianza como protagonista. La relación significativa entre la alianza terapéutica y los resultados de la terapia así como la interacción entre terapeuta y paciente como variable influyente en el desarrollo de la alianza son algunos de los aspectos que se destacan (AU)

Measuring coping style and resistance among Spanish and Argentine samples: development of the Systematic Treatment Selection Self-Report in Spanish.

This article reports the reliability and validity of the Coping Style and Resistance subscales of the Systematic Treatment Selection Self-Report (STS-SR) scale after its translation to Spanish. The English versions of the STS system identify eight empirically derived patient variables that have been found to moderate the effects of various classes of mental health treatment procedures. Research on these dimensions as treatment indicators, as assessed both by clinicians and through patient self-reports, indicates that they increase the efficiency and effectiveness of treatment among English-speaking samples. This article reports a study of the convergent and discriminant validity of two of the subscales, Coping Style and Trait Resistance. The subscales were translated English into Spanish and administered to large Spanish and Argentine subject pools, along with established measures of the same and related constructs. Results revealed that both scales possessed good internal consistency and adequate discriminant validity. The implications of these findings are discussed.