Contrasting Cases in Two Psychotherapeutic Processes Based on Integrative Behavior Couple Therapy / Contraste de casos en dos procesos psicoterapéuticos basados en la terapia de pareja conductual integradora

The present study proposes an evaluation of the therapeutic process in relation to the follow-ing aspects: the therapist adherence, the items which are more and less characteristic in the treatment and the interaction structures, along the therapeutic process of two cases of couple therapy,one with significant positive clinical change and one with significant negative clinical change, in the couple's evaluation. This work used Integrative Behavioral Couple Therapy mod-el, one of the approaches of the third wave therapies.The method was a study of contrasting cases. The similarities and differences between the cases were discussed, reaching the conclu-sion that there are aspects of the couple, the therapist, the therapeutic relationship and the context that may have contributed to the different outcomes. (AU)

El presente estudio propone una evaluación del proceso terapéutico en relación con los siguientes aspectos: la adherencia del terapeuta, los ítems más y menos característicos en el tratamiento y las estructuras de interacción, a lo largo del proceso terapéutico de dos casos de terapia de pareja, uno con cambio clínico positivo significativo y otro con cambio clínico negativo significativo, en la evaluación de la pareja. En este trabajo se utilizó el modelo de Terapia de Pareja Conductual Integrativa, uno de los enfoques de las terapias de tercera ola. El método fue un estudio de casos contrastados. Se discutieron las similitudes y diferencias entre los casos, llegando a la conclusión de que hay aspectos de la pareja, del terapeuta, de la relación terapéutica y del contexto que pueden haber contribuido a los diferentes resultados. (AU)

O que Terapeutas Comportamentais Aprendem para sua Prática Clínica na Relação Terapêutica? / What Do the Behavioral Therapists Learn for their Clinical Practice in the Therapeutic Relationship? / ¿Qué Aprenden los Terapeutas Conductuales para su Práctica Clínica en la Relación Terapéutica?

De acordo com a visão vigente, aprende-se a ser psicoterapeuta comportamental em cursos, onde se ensinam teoria, intervenções e técnicas; e na supervisão, onde a atuação do terapeuta é aprimorada. O objetivo deste estudo foi examinar uma terceira via de aprendizagem. O que os terapeutas aprendem na relação com seus clientes? Foram entrevistados 14 terapeutas analítico-comportamentais, cognitivo comportamentais ou comportamentais contextuais, a respeito do que aprenderam com seus clientes para sua prática clínica. A análise das transcrições foi pautada nos preceitos da grounded theory analysis. Os resultados sugerem que os terapeutas aprendem sobre algumas coordenadas importantes do processo terapêutico: a singularidade de cada cliente, a responsabilidade do cliente e do terapeuta para o processo e sobre as suas limitações como terapeuta. Expandem suas competências clínicas: como enxergar além de rótulos e julgamentos, assumir uma postura terapêutica, flexibilidade e autenticidade. Adquirem estratégias clínicas, aprendem a ceder espaço para o cliente, a respeitar o tempo do cliente e responder às suas necessidades. Finalmente, aprendem a manejar riscos e contrariedades, a lidar com a proximidade no relacionamento, como usar dos seus equívocos a favor da terapia e conduzir aspectos burocráticos da sua profissão.

According to the current view, the role of a behavioral therapist is trained in courses which theory, interventions and techniques are taught and in clinical supervision supervision where the beginner's performance is shaped. The aim of this study was to explore a third learning pathway. What do therapists learn in their relationship with their clients? Fourteen behavioral and cognitive-behavioral therapists were interviewed about what they learned from their clients. The transcripts were examined according to the precepts of grounded theory analysis. The results suggest that therapists learn about important coordinates of the therapeutic process: the uniqueness of each client, the client's and therapist's responsibility in the process, and also about therapists limitations. They expand their clinical competencies: how to see beyond labels and evaluations, to assume a therapeutic stance, be flexible and authentic. They acquire clinical strategies, learning to allow due space to the client, to respect the client's time and to respond to their needs. Finally, they learn how to manage risks and setbacks, to deal with closeness in the relationship, take advantage of their errors in favor of therapy and how to manage bureaucratic aspects of their profession.

Según la visión actual, la profesión de psicoterapeuta se aprende de los profesores que imparten teoría, intervenciones y técnicas y de los supervisores que acompañan la actuación. El objetivo de este estudio fue identificar una tercera vía de aprendizaje: ¿qué aprenden los terapeutas con sus clientes? Se entrevistó a catorce terapeutas conductuales y cognitivo-conductuales sobre lo que aprendieron con sus clientes. El análisis de datos se basó en los preceptos del análisis de teoría fundamentada. Los resultados sugieren que los terapeutas aprenden sobre las coordenadas importantes del proceso terapéutico: la singularidad de cada cliente, la responsabilidad del cliente y del terapeuta por el proceso y sus limitaciones como terapeuta. Los terapeutas amplían sus competencias clínicas: cómo ver más allá de las etiquetas y los juicios, adoptar una postura terapéutica, desarrollar flexibilidad y autenticidad. Adquirir estrategias clínicas, aprender a darle espacio al cliente, respetar el tiempo del cliente y responder a sus necesidades. Finalmente, aprenden a gestionar los riesgos y contratiempos, a lidiar con la proximidad al cliente, a aprovechar los conceptos erróneos a favor de la terapia y a gestionar los aspectos burocráticos de su profesión.

Use of Therapeutic Milieu Interventions in a Psychiatric Setting: A Systematic Review.

BACKGROUND: The therapeutic environment is commonly acknowledged as a significant influence on mental inpatient treatment experiences and outcomes. Therapeutic milieu interventions provide a distinct, secure hospital ward/unit atmosphere where patients with mental illness receive therapeutic interactions and collaborative attentiveness. The review aimed to explore the studies related to the role of a nurse using therapeutic milieu/milieu therapy in a psychiatric setting. MATERIALS AND METHODS: A systematic literature search was conducted between 1976 and 2021 using PsycINFO, Medline, Embase, and Scopus. A total of 13 papers were identified for a full review. RESULTS: A total of 70 studies were found, out of which 13 of them were analyzed. These studies looked at several therapeutic milieu concepts, such as therapeutic communication, patient satisfaction, nurse involvement, ward design and structure, and a mixture of therapeutic milieu concepts. Most of the studies explored the concepts of milieu therapy in community settings. CONCLUSION: In the mental health nursing literature, the milieu, as well as milieu therapy, is a well-debated subject. Though the importance of therapeutic milieu in psychiatric settings is recognized, empirical studies on milieu implementation are scarce. Therefore, research is needed to explore the effectiveness of milieu therapy in inpatient psychiatric care, which facilitates patient recovery, safety, and good interpersonal relationships.

Which, who and when? Therapeutic processes in group cognitive behaviour therapy for anxiety disorders.

The evidence for the effect of therapeutic alliance in group cognitive behaviour therapy (CBT) for anxiety disorders is unclear. Identifying whether the alliance-outcome relationship depends on (1) which components are assessed, (2) who is measuring the alliance and (3) when the alliance is measured will help to clarify the role of the client-therapist relationship in therapy. The present study explored the effects of alliance component (agreement vs. bond), rater perspective (client vs. therapist) and timing (early vs. late therapy) on the alliance-outcome relationship. Individuals with an anxiety disorder enrolled into transdiagnostic group CBT were studied, with n = 78 at early therapy and n = 57 at late therapy. Results showed that greater client-rated agreement significantly predicted improved post-treatment outcomes throughout the course of therapy, while stronger client-rated bond in late therapy predicted reduced treatment gains. In contrast, therapist perceptions of agreement and bond were not associated with post-treatment outcomes at any point in therapy. Client-reported group cohesion also was not associated with additional variance in outcome after accounting for client-rated alliance. Overall, the findings highlight the importance of prioritizing the client's perception of the client-therapist relationship in CBT for anxiety disorders, as well as distinguishing the effects of component, rater and timing in future process-outcome studies.

Psychotherapeutic and neurobiological processes associated with ayahuasca: A proposed model and implications for therapeutic use.

Ayahuasca is a psychoactive Amazonian plant brew. It is usually made from the Banisteriopsis caapi vine (Spruce ex Griseb. Morton, Malpighiaceae), which contains three primary harmala alkaloids, along with the leaves of Psychotria viridis (Ruiz et Pavon, Rubiaceae) in which the potent psychedelic dimethyltryptamine (DMT) is found. DMT-harmaloid concoctions have gained popularity in recent years, due to growing anecdotal and scientific reports of therapeutic benefits associated with their consumption. Ayahuasca is now ingested in a variety of different settings across the globe, from traditional ethnobotanical to so called "neo-shamanic" ceremonies. Furthermore, related preparations involving alternative sources of DMT and harmala alkaloids are becoming increasingly common as knowledge of ayahuasca continues to spread internationally. This article reviews the existing literature and draws on original qualitative data from a large cross-sectional study of ayahuasca drinkers, to propose a model of psychotherapeutic processes associated with the consumption of ayahuasca. We assert that it is these processes, facilitated by a range of neurobiological effects, that lead to beneficial mental health and wellbeing outcomes. Our proposed model identifies five key psychotherapeutic processes or effects inherent to the ayahuasca experience; somatic effects; introspection and emotional processing; increased Self-connection; increased spiritual connection, and finally the gaining of insights and new perspectives. We note some important differences in these processes compared with other classic psychedelics as well as the implications of the model for the therapeutic use of ayahuasca. Improved understanding of the psychotherapeutic processes involved with the ayahuasca experience will better equip practitioners to work with this potentially transformative concoction and enable the optimization of therapeutic treatment models for potential clinical use.

Can you see what I see? A comparison of client and observer perspectives of the alliance and group cohesion in CBT.

Both therapeutic alliance and group cohesion have been identified as "demonstrably effective" relationship elements in therapy. However, the overwhelming majority of process-outcome research has relied on clients as raters of the therapeutic relationship. A lack of convergence between client, therapist, and observer perspectives has raised questions regarding how best to measure relationships in therapy. Interest in observational measures has grown, as they may offer more objective and reliable measurements of process. This study compared the predictive validity of client and observer ratings of the alliance (Agreement and Bond) and group cohesion in the context of group cognitive behaviour therapy (CBT) for anxiety disorders. Results showed that client and observer ratings of process were not significantly correlated, and regarding the alliance, only client-rated Agreement predicted client-rated treatment gains. In contrast, both client and observer-ratings of group cohesion were found to uniquely contribute to treatment outcomes. If replicated, the findings from the present study suggest that (1) while client ratings of alliance consistently predict client-rated outcomes, the predictive validity of observer measures has yet to be established, and (2) both clients and observers provide meaningful and distinct information about group cohesion in therapy.

Research progress in comorbid bipolar disorder and obsessive-compulsive disorder / 中国基层医药

Bipolar disorder and obsessive-compulsive disorder comorbidity is becoming more and more common and has aroused clinical physicians' increasing interest. This review summarizes the epidemiology, clinical characteristics, neurobiochemistry, and treatment of comorbid bipolar disorder and obsessive-compulsive disorder and discusses the neurobiochemical mechanism. Findings from this review will provide evidence for identifying the clinical symptoms of bipolar disorder and obsessive-compulsive disorder comorbidity and for treatment of the comorbidity.

Psicanálise no tratamento multidisciplinar e cirúrgico da obesidade mórbida: estudo de caso / Psychoanalysis in the multidisciplinary and surgical treatment of morbid obesity: a case study / La psychanlyse dans le traitement multidisciplinaire et chirurgie de l'obésité morbide: une étude de cas / Psicoanálisis en el tratamiento multidisciplinario y quirúrgico de la obesidad mórbida: estudio de caso

O objetivo do estudo é avaliar o processo psicoterapêutico de abordagem psicanalítica kleiniana como contribuição na melhoria da saúde de pacientes submetidos a cirurgia bariátrica. O método é de estudo de caso baseado na análise de vinheta clínica, acompanhado de levantamento bibliográfico. Analisaram-se trechos de conversas do processo psicoterapêutico de uma mulher obesa de 53 anos que procurou uma instituição dedicada ao tratamento cirúrgico da obesidade grave com enfoque multiprofissional. Após diagnóstico de obesidade mórbida, foi efetuada uma avaliação psicológica inicial. Como extensão, seguiu-se o processo psicoterapêutico de abordagem psicanalítica com frequência de uma vez por semana, passando depois a duas vezes. Dois meses após o primeiro encontro, a paciente submeteu-se à cirurgia bariátrica. A psicoterapia já tem a duração de três anos. Como resultado, a paciente tornou-se mais capaz de entrar em contato com o sentimento de desamparo associado ao fator destrutividade, que aparece em cenas narrativas de vingança, inveja e ciúme. Concluiu-se que o processo psicanalítico se mostrou efetivo: a paciente adquiriu mais condições de preservar suas redes afetivas constituintes, e tornou-se menos vulnerável à ansiedade e impulsividade, favorecendo a permanência da redução da obesidade e evitando a formação de outras situações de padecimento, como o alcoolismo. Essas observações confirmam algumas referências já apontadas na literatura.

We assessed the psychotherapeutic process based on a Kleinian psychoanalytic approach as a contribution to improve the health of patients undergoing bariatric surgery. To that end, we performed a case study based on the analysis of a clinical vignette accompanied by a literature review. We analyzed excerpts of conversations of the psychotherapeutic process of a very obese 53-year-old woman who sought an institution dedicated to the surgical treatment of severe obesity relying on a multidisciplinary approach. After a diagnosis of morbid obesity, an initial psychological evaluation was performed. As an extension, a psychotherapeutic process based on a psychoanalytical approach took place once a week and then later twice a week. Two months after the first meeting, the patient underwent bariatric surgery. To date, the psychotherapeutic process has lasted for three years. As a result, the patient managed to get in touch with her feeling of helplessness associated with a destructiveness factor, which appears in narrative scenes of revenge, envy and jealousy. We conclude that the psychoanalytic process proved to be effective: the patient was able to preserve her constituent affective networks and became less vulnerable to anxiety and impulsivity, favoring reduction of obesity and avoiding situations of suffering such as alcoholism. Our observations confirm some references already mentioned in the literature.

Le but de cette étude est d'évaluer le processus psychothérapeutique à l'aide d'une approche psychanalytique kleinienne pour contribuer à l'amélioration de la santé des patients subissant une chirurgie bariatrique. Pour atteindre ce but, une étude de cas a été développée à partir de la littérature et de l'analyse de vignettes cliniques et on a analysé des extraits de conversations du processus psychothérapeutique d'une femme de 53 ans qui recherchait une institution de traitement chirurgical de l'obésité sévère qui a pour base une approche multidisciplinaire. Après un diagnostic d'obésité morbide, un premier bilan psychologique a été réalisé. En prolongement, le processus psychothérapeutique basé sur une approche psychanalytique a été suivi, une fois par semaine au début et plus tard deux fois par semaine. Deux mois après la première rencontre, la patiente a subi une chirurgie bariatrique. La psychothérapie dure depuis trois ans et a permis à la patiente de faire face à son sentiment de détresse associé au facteur destructif qui surgit dans des scènes narratives de vengeance, d'envie et de jalousie. On conclut que le processus psychanalytique s'est avéré efficace: la patiente a réussi à préserver ses réseaux constitutifs affectifs et est moins vulnérable à l'anxiété et à l'impulsivité, favorisant la permanence de la réduction de l'obésité et évitant la formation d'autres situations de souffrance, comme l'alcoolisme. Ces observations confirment certaines références que l'on trouve dans la littérature.

El objetivo del estudio es evaluar el proceso psicoterapéutico a través de un enfoque psicoanalítico kleiniano como contribución a la mejora de la salud de los pacientes sometidos a cirugía bariátrica. Se trata de un estudio de caso basado en el análisis de una viñeta clínica acompañada por una encuesta bibliográfica. Se analizaron extractos de conversaciones del proceso psicoterapéutico de una mujer obesa de 53 años que acudió a una institución dedicada al tratamiento quirúrgico de la obesidad severa con un abordaje multidisciplinario. Después de un diagnóstico de obesidad mórbida, se realizó una evaluación psicológica inicial. Como extensión, se siguió el proceso psicoterapéutico con enfoque psicoanalítico, inicialmente, una vez por semana y después, dos veces por semana. Dos meses después del primer encuentro, la paciente fue sometida a cirugía bariátrica. La psicoterapia ha durado tres años. Como resultado, la paciente se volvió más capaz de conectarse al sentimiento de desamparo asociado al factor destructividad, que aparece en escenas narrativas de venganza, envidia y celos. Se concluyó que el proceso psicoanalítico resultó ser efectivo: la paciente adquirió más condiciones para preservar sus redes afectivas constituyentes y se volvió menos vulnerable a la ansiedad y a la impulsividad, favoreciendo la permanencia de la reducción de la obesidad y evitando la formación de otras situaciones de sufrimiento, como el alcoholismo. Estas observaciones confirman algunas referencias ya mencionadas en la literatura.

[Psychotraumatological aspects in intensive care medicine]. / Psychotraumatologische Aspekte in der Intensivmedizin.

In the context of intensive care medicine, patients, their relatives, and more infrequently members of the ICU team can be affected by potential trauma. Acute stress disorder often results. Psychological symptoms of critically ill patients should therefore be regularly screened in a standardized manner in order to be able to identify and treat patients with a high symptom burden. Some traumatic stressors in intensive care medicine can be reduced using trauma-sensitive communication. Psychological and psychotherapeutic interventions can complement this basic care. High quality communication with relatives contributes to a risk reduction with regard to their subsequent psychological stress. On the part of the ICU team, stress should be differentiated from potentially traumatizing events and both problem areas should be dealt with preventively. After experiencing a traumatic event during work, a procedure analogous to physical work accidents is recommended.

As queixas escolares no serviço-escola: evolução dos casos / School complaints in a teaching-service: assistance evolution / Las quejas escolares en el servicio escolar: evolución de casos

As queixas escolares compreendem as dificuldades no processo de escolarização, seja de ordem pedagógica, relacional ou comportamental. Esta pesquisa teve como objetivo identificar as condutas adotadas e a evolução dos casos de crianças usuárias do serviço-escola de Psicologia da Universidade Federal do Triângulo Mineiro com queixas escolares, no período de 2013 a 2017, na faixa etária compreendida entre sete e 12 anos incompletos. Trata-se de uma pesquisa documental, com 60 prontuários analisados. Foram encontradas, na maioria dos prontuários, crianças do sexo masculino, de escola pública, e atendidas na modalidade de psicodiagnóstico. Foram observados grande desistência dos atendimentos, culpabilização da criança e da família, e pouco contato com a escola. Considera-se necessário compreender todos os ambientes nos quais a criança se encontra inserida (AU).

School complaints include difficulties in the schooling process, such as pedagogical, socialization or behavioral. The study aimed to identify the conducts adopted and the psychological assistance evolution of children using the University Psychology teaching-service. Those selected children had to be with school complaints from 2013 to 2017 and between the ages of seven and 12 years. This is a documentary study, with 60 psychological records analyzed. Most of these records were of male children, from public schools, and attended in the modality of psychodiagnosis. The result shows a large drop in attendance, family's and child's blaming, and lack of contact with the school. It is considered necessary to understand all environments in which the child is into (AU).

Las quejas escolares comprenden las dificultades en el proceso de escolarización, sea pedagógica, de socialización o de comportamiento. La investigación tuvo como objetivo identificar las conductas adoptadas y la evolución de los casos de niños usuarios del servicio-escuela de Psicología de la Universidade Federal do Triângulo Mineiro con quejas escolares, entre 2013 a 2017, entre las edades de siete y 12 años incompletos. Es una investigación documental, con 60 registros psicológicos analizados. Se encuentra, en la mayoría de los registros, niños del sexo masculino, de escuela pública, y asistidos en la modalidad de psicodiagnóstico. Se observó que la responsabilidad recae en el niño y la familia, gran desistimiento de las asistencias y poco contacto con la escuela. Se considera necesario comprender todos los ambientes en que se inserta el niño (AU).

Elements of the therapeutic relationship in CBT for anxiety disorders: A systematic review.

To optimise the effects of cognitive behaviour therapy (CBT) for anxiety disorders, research has increasingly focussed on understanding mechanisms of change. Specifically, the therapeutic relationship has been identified as a potential "active ingredient" of therapy. The evidence for the effects of eleven elements of the therapeutic relationship (alliance, collaboration, goal consensus, group cohesion, empathy, positive regard, feedback, emotional expression, outcome expectations, treatment credibility, alliance rupture-repair) on treatment outcomes in CBT for anxiety disorders was systematically reviewed. Fifty unique studies were included, and findings were qualitatively reviewed and summarised. Results revealed consistent and sizeable evidence for the cohesion-outcome and expectation-outcome relationships. There was emerging evidence for the effects of collaboration, empathy, and alliance rupture-repair on outcomes. However, the evidence for goal consensus and credibility on outcomes was limited. Notably, review of the alliance literature revealed substantial inconsistencies across studies. No studies were identified for positive regard, feedback, and emotional expression. Overall, further research is needed to clarify the role of the therapeutic relationship in CBT for anxiety disorders. These findings will contribute to the conceptual integration of therapeutic relationship constructs in cognitive behavioural models, and help to improve treatments and outcomes for individuals.

[Psychotraumatological aspects in intensive care medicine]. / Psychotraumatologische Aspekte in der Intensivmedizin.

In the context of intensive care medicine, patients, their relatives, and more infrequently members of the ICU team can be affected by potential trauma. Acute stress disorder often results. Psychological symptoms of critically ill patients should therefore be regularly screened in a standardized manner in order to be able to identify and treat patients with a high symptom burden. Some traumatic stressors in intensive care medicine can be reduced using trauma-sensitive communication. Psychological and psychotherapeutic interventions can complement this basic care. High quality communication with relatives contributes to a risk reduction with regard to their subsequent psychological stress. On the part of the ICU team, stress should be differentiated from potentially traumatizing events and both problem areas should be dealt with preventively. After experiencing a traumatic event during work, a procedure analogous to physical work accidents is recommended.

Joint Consultation by a Neurogeneticist of Movement Disorders and a Psychodynamic Psychotherapist: An Occasion for Subjectivization.

We set out to model a joint therapeutic setting meant to address both medical care and the transferential processes at stake in specialized neurogenetics consultations. Previous authors have explored joint consultation settings with a specialized physician and a psychodynamically oriented psychotherapist, however, few have attempted to provide a model of its transfero-countertransferential dynamics. We aim to do the latter by focusing on a subset of patients to whom such consultations are offered "on the spot." We want to explore situations in which they initially deny the transference's contribution to their complaint, when addressing it would instead prove to be beneficial to them, even medically speaking. Standard neurogenetics consultations put the physician in a double-bind position. These patients' conflicting complaint both manifests transferential expectations and denies them by adhering to medical elements. Since the physician's challenge is to avoid colluding with the patient's denial, a joint setting would enable him to address the medical content of the patient's complaint while simultaneously letting its transferential elements emerge, allowing for the psychotherapist to use them to induce subjective integration (subjectivization). We conceptualize this jointly induced subjectivization by drawing on Fain's work on primary hystericization of the complaint (inspired by Freud's late indications). We finish with an example of subjectivization of a family's complaint based on an adolescent's limb tremor, which had no genetic or neurological etiology. Its seemingly conversional nature appeared in light of her father's reaction to our subjectivizing response: his latent transference was likely underlying his daughter's symptom.

Psicoterapia de abordagem gestáltica: um olhar reflexivo para o modelo terapêutico / Gestalt psychotherapy: a reflective look at the therapeutic model / Psicoterapia de enfoque gestáltica: una mirada reflexiva hacia el modelo terapéutico

Tendo em vista a relevância da Gestalt-Terapia (GT) para o cenário atual da Psicologia, este estudo apresenta reflexões teóricas sobre os fundamentos filosóficos e teórico-epistemológicos que sustentam essa abordagem. Por meio de breve retrospectiva histórica, a pesquisa localiza o surgimento da abordagem em um cenário então dominado pelas perspectivas psicanalítica e comportamental. A seguir, são abordados os fundamentos teórico-epistemológicos que sustentam e norteiam as intervenções da GT. Em seguida, discorre-se conceitualmente sobre o modelo terapêutico da GT, concentrando-se na análise de conceitos como aqui-agora, 'awareness' e fronteiras de contato. A última parte é dedicada à consideração de apontamentos críticos e identificação de limitações da GT. A partir das reflexões desenvolvidas, entende-se que a intervenção terapêutica em GT privilegia a experiência presente e tem por objetivo restaurar o contato, utilizando para tanto a relação dialógica. Na abordagem gestáltica, o indivíduo é considerado um ser provisório que está em permanente construção, a partir das relações que estabelece. Essas relações acompanham o movimento de inacabamento, inerente à condição do homem, e a eterna reconstrução que caracteriza o devir humano. Ao final, demonstra-se que a GT reúne um acervo que contribui de modo significativo não apenas para a clínica psicoterápica, como também para o avanço do saber psicológico.

Given the relevance of Gestalt-Therapy (GT) to the current scenario of Psychology, this study presents some theoretical reflections on the philosophical and theoretical-epistemological foundations that support this approach. Through a brief historical retrospective, the study locates the emergence of the approach in a scenario then dominated by the psychoanalytic and behavioral perspectives. Next, the theoretical-epistemological foundations that support and guide GT interventions are addressed. Conceptual discourse is then discussed about the therapeutic model of GT, focusing on the analysis of concepts such as here-now, awareness, and contact boundaries. The last part is devoted to the consideration of critical notes and limitations of GT. From the reflections developed, it is understood that the therapeutic intervention in GT privileges the present experience and its function is to restore the contact, using to that end the dialogical relation. In the Gestalt approach, the individual is considered a provisional being, which is under permanent construction, based on the relationships established. These relations accompany the movement of unfinishedness, inherent to the human condition, and the eternal reconstruction that characterizes becoming human. Finally, it is shown that the GT brings together a collection that contributes significantly not only to the psychotherapeutic clinic, but also to the advancement of psychological knowledge.

En vista de la relevancia de la Gestalt-Terapia (GT) para el escenario actual de la Psicología, este estudio presenta algunas reflexiones teóricas sobre los fundamentos filosóficos, teóricos y epistemológicos que sostienen ese abordaje. Por medio de una breve retrospectiva histórica, el estudio localiza el surgimiento del abordaje en un escenario entonces dominado por las perspectivas psicoanalítica y conductual. Así, se abordan los fundamentos teórico-epistemológicos que sostienen y orientan las intervenciones de la GT. En seguida se discurre conceptualmente sobre el modelo terapéutico de la GT, concentrándose en el análisis de conceptos como aquí-ahora, 'awareness' y fronteras de contacto. La última parte está dedicada a la consideración de apuntes críticos y limitaciones de la GT. A partir de las reflexiones desarrolladas se entiende que la intervención terapéutica en GT privilegia el experiencia presente y tiene por función restaurar el contacto, utilizando, para tanto, la relación dialógica. En el abordaje gestáltico el individuo es considerado un ser provisional, que está en permanente construcción, a partir de las relaciones que establece. Estas relaciones acompañan el movimiento de inacabamiento, que es inherente a la condición del hombre, y la eterna reconstrucción que caracteriza al devenir humano. Al final, se demuestra que la GT reúne un acervo que contribuye de modo significativo no sólo a la clínica psicoterápica, sino también al avance del saber psicológico.

Agents of change: Understanding the therapeutic processes associated with the helpfulness of therapy for mental health problems with relational agent MYLO.

OBJECTIVE: To understand the therapeutic processes associated with the helpfulness of an online relational agent intervention, Manage Your Life Online (MYLO). METHODS: Fifteen participants experiencing a mental health related problem used Manage Your Life Online for 2 weeks. At follow-up, the participants each identified two helpful and two unhelpful questions posed by Manage Your Life Online within a single intervention session. Qualitative interviews were conducted and analyzed using thematic and content analysis to gain insight into the process of therapy with Manage Your Life Online. RESULTS: MYLO appeared acceptable to participants with a range of presenting problems. Questions enabling free expression, increased awareness, and new insights were key to a helpful intervention. The findings were consistent with the core processes of therapeutic change, according to Perceptual Control Theory, a unifying theory of psychological distress. Questions that elicited intense emotions, were repetitive, confusing, or inappropriate were identified as unhelpful and were associated with disengagement or loss of faith in Manage Your Life Online. CONCLUSIONS: The findings provide insight into the likely core therapy processes experienced as helpful or hindering and outlines further ways to optimize acceptability of Manage Your Life Online.

Predictors of Anxiety and Depression Symptom Improvement in CBT Adapted for Traumatic Brain Injury: Pre/Post-Injury and Therapy Process Factors.

OBJECTIVES: The current study examined the association of demographic/preinjury, injury-related, and cognitive behavior therapy (CBT) process variables, with anxiety and depression symptom change in traumatic brain injury (TBI)-adapted CBT (CBT-ABI). METHODS: The audio recordings of 177 CBT-ABI sessions representing 31 therapist-client dyads were assessed from the independent observer perspective on measures of working alliance, homework engagement, and therapist competency in using homework. RESULTS: Linear regressions showed that older client age, longer post-TBI recovery period, better executive functioning, higher levels of client homework engagement, as well as higher levels of therapist competence in reviewing homework were associated with greater improvement in anxiety and/or depression symptoms. CONCLUSIONS: CBT-ABI is a promising treatment for post-TBI depression and anxiety. The current study highlights how therapists can enhance CBT-ABI effectiveness, specifically: comprehensive facilitation of client homework engagement with emphasis on homework review, and accommodation of executive deficits. The current study also suggests that the role of client age and the length of post-TBI recovery period require further investigation.

Does involving patients in treatment decisions affect perceptions of treatments and therapists?

Psychotherapists may offer patients more or less involvement when deciding on a treatment. The aim of the present research was to examine whether perceptions of the treatment and therapist differ when a therapist uses a paternalistic style in making treatment decisions or a more collaborative approach, in which the patient helps in selecting treatment. In the study, 172 participants, recruited from a university setting and a national sample, listened to a simulated conversation representing either a paternalism or informed-choice model of a therapist-patient interaction. The participants then rated their expectation the treatment would help the patient, their perception of the therapist's trustworthiness, and their own preference for relying on clinicians for knowledge and decisions. Analysis indicated that among participants preferring to rely on clinicians, perceptions did not differ reliably based on the type of interaction they heard. However, participants wanting more involvement in treatment choices perceived greater treatment effectiveness and clinician trustworthiness for the interaction in which the patient was offered treatment choices. These results suggest that if therapists adopt a collaborative approach, it has the potential to enhance perceptions of individuals preferring the collaborative style without negatively affecting those who prefer less involvement in treatment decisions.

Do acolhimento da queixa à compreensão da demanda na terapia centrada no cliente / From the complaint reception to the demand understanding in client-centered therapy

Este artigo objetiva fazer uma reflexão teórica sobre o acolhimento da queixa e a compreensão da demanda no processo clínico da terapia centrada no cliente, de Carl Rogers. Inicialmente, apresenta uma distinção entre queixa e demanda e argumenta que o acolhimento da queixa e sua conversão em demanda faz parte do manejo clínico. Posteriormente, apresenta algumas noções rogerianas para entender como se estruturam os fenômenos da queixa e da demanda. Em seguida, descreve os aspectos relacionados ao acolhimento da queixa e sua conversão em demanda, segundo o desenvolvimento do processo terapêutico, via consideração positiva incondicional e compreensão empática. Conclui que a terapia centrada no cliente possui implicações conceituais que possibilitam um olhar clínico sobre tais fenômenos em relação aos seus aspectos constituintes, distintivos e conversivos. Sugere, finalmente, outras reflexões e estudos empíricos.(AU)

This article aims to make a theoretical reflection on the complaint reception and the demand understanding in the clinical process of the client-centered therapy, by Carl Rogers. Initially, presents a distinction between complaint and demand and argues that the complaint reception and its conversion into demand are part of the clinical management. Subsequently, presents some rogerian notions to understand how the complaint and demand phenomena are structured. It then describes the aspects related to the complaint reception and its conversion into demand, according to the therapeutic process development, through unconditional positive consideration and empathic understanding. Concludes that the client-centered therapy has conceptual implications that enable a clinical view of these phenomena in relation to their constituent, distinctive and conversion aspects. Finally, suggests other reflections and empirical studies.(AU)

Este artículo tiene como objetivo hacer una reflexión teórica sobre la recepción de la queja y la comprensión de la demanda en el proceso clínico de la terapia centrada en el cliente, de Carl Rogers. Inicialmente, presenta una distinción entre queja y demanda y argumenta que la recepción de la queja y su conversión en demanda son parte del manejo clínico. Posteriormente, presenta algunos conceptos de Rogers para entender cómo se estructuran los fenómenos de la queja y de la demanda. En seguida, describe los aspectos relacionados con la recepción de la queja y su conversión para demanda, según el desarrollo del proceso terapéutico, mediante la consideración positiva incondicional y la comprensión empática. Concluye que la terapia centrada en el cliente tiene implicaciones conceptuales que posibilitan una mirada clínica sobre tales fenómenos en relación a sus aspectos constituyentes, distintivos y de conversión. Sugiere, finalmente, otras reflexiones y estudios empíricos.(AU)

Modalidades de atendimento à população por serviços-escola de Psicologia: panorama das publicações / Types of services available to the population by Psychology Training Clinics: a comprehensive view of publications

O artigo toma como objeto de estudo as modalidades disponibilizadas de atendimento à população por serviços-escola de Psicologia. Parte do pressuposto de que a formação e a atuação em Psicologia têm sido perpassadas por significativas mudanças no contexto sócio-histórico-político do Brasil. Das clássicas áreas educação, saúde e trabalho, a Psicologia passa a responder demandas de distintos campos da vida da população. Trata-se de estudo descritivo, quantitativoqualitativo, constituído de levantamento bibliográfico da produção científica (2011 a 2015) sobre o tema. Vinte e quatro artigos foram identificados na pesquisa e sistematizados em três blocos de conteúdo: atividades educacionais, de autoavaliação e clínicas. As publicações versam prioritariamente sobre atividades educacionais e clínicas, sendo estas as que reúnem maior quantidade de artigos. Devido à tarefa dirigida à Psicologia de responder a demandas com as quais historicamente não se envolveu, pelo menos de forma hegemônica, é indispensável problematizar o Serviço-escola em sua função pedagógica, ético-política e social.

This article investigates the types of service available to the population by Psychology Training Clinics. It is based on the assumption that training and practice in Psychology have been permeated by significant changes in the sociohistorical-political context of Brazil. From the classic fields of school, health and work, Psychology starts to respond to demands from different areas of population life. This is a descriptive, quantitative-qualitative study, consisting of a literature review on the subject (2011 to 2015). 24 articles were identified in the search of the literature and analysed in three content blocks: school, self-assessment and clinical activities. The publications are primarily about educational and clinical activities, and they bring together a greater number of articles. Due to the task directed to Psychology to respond to the demands with which it has historically not been involved, at least in a hegemonic way, it is indispensable to problematize the Psychology Training Clinic in its pedagogical, ethical-political and social function.

Implementation of a Web-Based Work-Related Psychological Aftercare Program Into Clinical Routine: Results of a Longitudinal Observational Study.

BACKGROUND: As inpatient medical rehabilitation serves to promote work ability, vocational reintegration is a crucial outcome. However, previous Web-based trials on coping with work-related stress have been limited to Web-based recruitment of study participants. OBJECTIVE: The aim of our study was to evaluate the implementation of an empirically supported transdiagnostic psychodynamic Web-based aftercare program GSA (Gesund und Stressfrei am Arbeitsplatz [Healthy and stress-less at the workplace])-Online plus into the clinical routine of inpatient medical rehabilitation, to identify characteristics of patients who have received the recommendation for GSA-Online plus, and to determine helpfulness of the intervention and satisfaction of the participants as well as improvement in quality of life and mental health status of the regular users of GSA-Online plus. METHODS: GSA-Online plus was prescribed by physicians at termination of orthopedic psychosomatic inpatient rehabilitation. Participants' use of the program, work-related attitudes, distress, and quality of life were assessed on the Web. RESULTS: In 2 rehabilitation centers, 4.4% (112/2562) of rehabilitants got a recommendation for GSA-Online plus during inpatient rehabilitation. Compared with usual person aftercare, the Web-based aftercare program was rarely recommended by physicians. Recommendations were made more frequently in psychosomatic (69/1172, 5.9%) than orthopedic (43/1389, 3.1%) rehabilitation (χ21=11.845, P=.001, Cramér V=-0.068) and to younger patients (P=.004, d=0.28) with longer inpatient treatment duration (P<.001, r=-0.12) and extended sick leaves before inpatient medical rehabilitation (P=.004; Cramér V=0.072). Following recommendation, 77% (86/112) of rehabilitants participated in Web-based aftercare. Completers (50/86, 58%) reported statistically significant improvements between discharge of inpatient treatment and the end of the aftercare program for subjective work ability (P=.02, d=0.41), perceived stress (P=.01, d=-0.38), functioning (P=.002, d=-0.60), and life satisfaction (P=.008, d=0.42). CONCLUSIONS: Physicians' recommendations of Web-based aftercare are well accepted by patients who derive considerable benefits from participation. However, a low rate of prescription compared with other usual aftercare options points to barriers among physicians to prescribing Web-based aftercare.