Analysis of the role of motivating operations in the therapeutic verbal interaction / Análisis del rol de las operaciones motivadoras en la interacción verbal terapéutica

El concepto de operación motivadora (OM) ayuda a suplir los problemas de la noción tradicional de motivación en el estudio del proceso terapéutico. En este trabajo, se analizó el rol de tres tipos de verbalizaciones del terapeuta con una función de OM y se comprobó su relación con el comportamiento verbal de los clientes. Para tal propósito, se observaron grabaciones de 40 sesiones de terapia pertenecientes a 9 casos diferentes. El Sistema ACOVEO fue el sistema de categorías empleado para identificar las categorías OM con información clínica, OM con consecuencias y OM con emparejamiento. El SISC-CVC fue aquel utilizado para identificar las verbalizaciones de las clientes codificadas como Acuerdo y Desacuerdo. Se llevaron a cabo análisis secuenciales para comprobar la relación entre las diferentes OMs entre ellas y con el acuerdo del cliente. Los resultados mostraron que las diferentes OMs fueron emitidas en bloque y que cuando la categoría OM con información clínica se emitía con OM con consecuencias o con OM con emparejamiento se encontraba una mayor asociación con la categoría de Acuerdo (r = 2.47; r = 1.86) que con la de Desacuerdo (r = -.53; r = -.36). Estos resultados destacan la importancia de la emisión de OMs que asocian de manera directa el comportamiento del cliente con eventos con un componente elicitador, ofreciendo estrategias más eficaces para los terapeutas.(AU)

The concept of motivating operation(MO) helps to overcome both theoretical and practical problems of the traditional notion of motivation in the study of the therapeutic process. In this research, the role of three types of therapists’ verbalizations with an MO functionwas analyzed, in addition to their association with clients’ verbal behavior. For this purpose, recordings of 40 clinical sessions belonging to 9 different cases were ob-served. The ACOVEO System was the observational category system used to identify the therapists’ verbal MOs coded as MO with clinical information, MO with consequences, andMO with pairings. The SISC-CVC was the one used to identify clients’ verbalizations coded as Agreementand Disagreement. Se-quential analyses were performed to test the relation between the three dif-ferent types of MOs with themselves, as well as with clients’ concurrence. Results showed that the different MOs were emitted in chunks and when MO with clinical information was uttered either with MO with consequences or MO with pairingsthere was a greater association with Agreement(r = 2.47; r = 1.86) rather than with Disagreement (r = -.53;r = -.36). These findings high-light the importance of the emission of MOs that associate directly events with an eliciting component with clients’ behavior, giving more efficacious strategies to the therapists.(AU)

Equivalence Class Formation in Adults with Severe Behavioral Problems.

Stimulus equivalence is a behavioral phenomenon that has been related to complex human behavior (e.g., remembering, cognitive functioning, and symbolic behavior). As a rule, people diagnosed with severe mental disorders (e.g., schizophrenia, bipolar disorder) that exhibit delusional and hallucinatory behavior, and disorganized speech have shown cognitive impairment (e.g., processing speed, reasoning/problem solving). Not enough research has analyzed the stimulus equivalence performance in this population. This study aims to investigate the stimulus equivalence performance in adults diagnosed with severe mental disorders. In particular, this study analyzes the many-to-one (MTO) and one-to-many (OTM) training structures effects, and the simultaneous (SIM) and the simple-to-complex (STC) training and testing protocol effects on equivalence class formation in this population. To achieve it, we analyzed the behavior of 18 participants diagnosed with severe mental disorders in three different conditions (Condition 1 OTM/SIM; 2 MTO/SIM; and 3 MTO/STC). Behavior consistent with stimulus equivalence was found in 11 out of 13 participants who had finished the study (5 participants decided to leave before completing the tasks). STC yielded better results than the SIM protocol. No differences were found between MTO and OTM training structures. Implications and suggestions for further research have been discussed.

Asignación de tareas terapéuticas y revisión de su cumplimiento desde una perspectiva conductual: las secuencias verbales entre terapeuta y cliente / Assignment of therapeutic tasks and review of their fulfillment from a behavioral perspective: the verbal sequences between therapist and client

Las tareas terapéuticas (tareas para casa) constituyen una estrategia propia de la psicología conductual para conseguir el cambio clínico. El presente estudio tiene como objetivo determinar cómo los terapeutas conductuales asignan las tareas terapéuticas y cómo revisan el cumplimiento. Se analizó la interacción verbal entre el terapeuta y el cliente en 211 sesiones grabadas (19 casos completos de éxito) mediante metodología observacional, a través del uso de un sistema de categorización (SIS-INTER-INSTR). Los valores de fiabilidad inter e intrajueces fueron entre buenos y excelentes. Los resultados muestran que los psicólogos conductuales emiten verbalizaciones motivadoras cuando asignan tareas terapéuticas. En la revisión del cumplimiento, frecuentemente refuerzan el cumplimiento de las tareas, pero dejan de evaluar el cumplimiento cuando el cliente informa que las ha realizado de forma parcial. Las secuencias verbales obtenidas proporcionan información sobre cómo los terapeutas conductuales dan instrucciones sobre las tareas terapéuticas y como revisan su cumplimiento. Esta información es un primer paso en el estudio de cómo esas secuencias pueden predecir o contribuir al establecimiento de una óptima colaboración terapéutica y a la eficacia del tratamiento. (AU)

Therapeutic (homework) tasks are a characteristic strategy in behavioral psychology to achieve clinical change. The aim of the present study is to determine how behavioural therapists assign therapeutic tasks and review their compliance. Observational methodology was used to analyse the verbal interaction of therapists and clients in 211 recorded sessions (19 complete successful cases) using a validated coding system (SIST-INTER-INSTR). The values for inter- and intra-judge reliability were from good to excellent. The study shows that behavioural psychologists offer motivating verbalisations when assigning therapeutic tasks. During the review of task compliance, therapists frequently provide positive reinforcement when clients report complete compliance with the assigned task but stop the review of tasks when clients report non-compliance or only partial compliance with the task. These sequences provide information about how behavioural therapists provide instructions for therapeutic tasks and review their compliance. This is a first step to study how these verbal sequences favour the establishment of TC and the effectiveness of treatment. (AU)

¿Qué sabemos sobre las variables que subyacen a la actuacióndel terapeuta altamente eficaz?Una revisión sistemática / What do we know about highly effective therapists? A systematic review

Los terapeutas altamente eficaces son aquellos que logran sis-temáticamente elevados niveles de éxito terapéutico. Sin embargo, aunque se contraste empíricamente dicha eficacia inter-terapeuta, todavía no se co-nocen cuáles son las conductas que explican este desempeño diferenciado. El objetivo de este trabajo es identificar las variables asociadas a estos tera-peutas altamente eficaces, sus definiciones, los parámetros de medida de éxito y la precisión con la que se miden los constructos de interés. Para ello, se realizó una revisión sistemática (RS) con publicaciones entre los años 2000 y 2020 de las bases de datos Scopus, MEDLINE/PubMed, Web of Science, PsycInfo, Google Académico y ProQuest Research Library. Se seleccionaron 2784 artículos empíricos, de los cuales 31 cumplieron los cri-terios de inclusión. Los principales resultados muestran que hay casi 50 va-riables predictoras del efecto del terapeuta. Se resume y se define cada una de estas variables psicológicas y se concluye que para lograr explicar el alto nivel de éxito inter-terapeuta es necesario incrementar la validez de cons-tructo de las variables predictivas, adecuar el diseño de las investigaciones e incluir datos con respecto a la interacción entre el terapeuta y su cliente.(AU)

Highly effective therapists are clinicians who systematically achieve excellent therapeutic outcomes. Although these types of therapists can be found among different therapies, the variables that could explain their performance remain uncertain. Therefore, to clarify these variables, analyze their definition, their objective measures, and the extent to which they measure what they claim, a systematic review (SR) was conducted. Publications between 2000 and 2020 -from Scopus, MEDLINE/PubMed, Web of Science, PsycInfo, Google Scholar and ProQuest Research Library databases-were included. After analyzing 2784 empirical works, 31 studies have met the inclusion criteria. The results made it possible to identify, summarize and define almost 50 predictor variables of therapist effect. The need toincrease construct validity, to improve empirical designs and to measure therapist-client interaction is discussed.(AU)

Verbal interaction pattern analysis in clinical psychology.

Recent developments in pattern analysis research have made this methodology suitable for the study of the processes that are set in motion in psychological interventions. Outcome research, based on the comparison between clinical results from treatment and control groups, has leveraged our empirical knowledge about the efficacy of psychological interventions. However, these methods of research are not precise enough for the analysis of these processes. On the contrary, pattern analysis could be a powerful tool to study moment-to-moment interactions typical of psychological interventions. This is methodology is relevant because clinical psychology is experiencing a paradigm shift from a protocol for syndrome perspective to a principle-based and person-centered intervention. This evidence-based, theory-grounded, and process-oriented paradigm of clinical intervention needs new research methods to thrive (i.e., pattern analysis). The analysis of the therapeutic relationship built into the verbal interaction between the clinician and the client is one of the cornerstones of this new era of research. So, the purpose of this article is three-fold: (1) to discuss the role of the verbal interaction pattern analysis in the clinical context to the development of the principle-based clinical psychology, (2) to analyze the patterns of verbal interaction in a clinical case, and (3) to compare the results using two different methods. To reach these purposes, using the observational methodology, we have coded the verbal interaction of 16 clinical sessions with a person diagnosed with a borderline personality disorder. We have analyzed the data using sequential analysis (GSEQ) and pattern recognition algorithms (i.e., T-Pattern detection). We have been able to detect typical patterns during different phases of psychological intervention (i.e., evaluation, explanation, treatment, and consolidation). Finally, the conceptual, methodological, and empirical implications of this study will be discussed within the realms of pattern analysis research and principle-based clinical psychology.

Eficiencia de las terapias: ¿un paso más allá de la eficacia? Análisis crítico del modelo cognitivo-conductual / Efficiency of therapies: A step beyond effectiveness? Critical analysis of the cognitive-behavioral model

La proliferación de la investigación de resultados ha colocado al modelo cognitivo-conductual como la terapia de elección para la mayoría de problemas psicológicos. Este tipo de investigación deja a un lado el análisis de los procesos de cambio conductual que subyacen al éxito de las diferentes técnicas de tratamiento, ya no sería importante saber qué es lo que hace que una técnica funcione siempre que ésta sea eficaz. Como consecuencia, el modelo cognitivo-conductual ha perdido la reflexión teórica y la fundamentación experimental que caracterizaba a la modificación de conducta sobre la cual se sustentaba en sus orígenes. Desde nuestra perspectiva, la investigación de procesos sería un paso previo necesario a la investigación de resultados de forma que los primeros puedan explicar cómo y por qué funcionan los tratamientos psicológicos, evitando así que el clínico se limite a aplicar procedimientos descritos en manuales protocolizad

The proliferation of outcome research has placed the cognitive-behavioral model as the therapy of choice for most psychological problems. This type of research leaves aside the analysis of behavioral change processes that underlie the success of different treatments techniques. Therefore, it would no longer be important to know what is that makes a technique works as long as it gives the expected results. Consequently, the cognitive-behavioral model has lost the theoretical reflection and the experimental foundation that characterized the modification of behavior on which it was based on its origins. From our perspective, process research would be a necessary preliminary step to outcome research so that it could explain how and why psychological treatments work, avoiding that the clinician simply applies the procedures described in the standardized manuals