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)

A comunicação de más notícias em saúde: aproximações com a abordagem centrada na pessoa / The communication of bad news in health: approximations with the person-centered approach / La comunicación de malas noticias en salud: aproximaciones con el enfoque centrado en la persona

A forma de comunicar más notícias impacta diretamente na adesão ao tratamento por parte do paciente. Frente às dificuldades em comunicar más notícias, foram elaborados protocolos que auxiliassem os profissionais de saúde nesses momentos de maior vulnerabilidade. Este estudo teórico teve por objetivo aproximar as atitudes/condições facilitadoras descritas originalmente por Carl Rogers no contexto psicoterápico a três protocolos de comunicação de más notícias frequentemente relatados na literatura da área: SPIKES, CLASS e P-A-CI-E-N-T-E. Diversas etapas desses protocolos emergem como ações que se aproximam ora da congruência/autenticidade, ora da consideração positiva incondicional ou da empatia, tornando lícito afirmar que a comunicação de más notícias também possibilita o estabelecimento de uma relação de ajuda. Conclui-se que esta associação entre os protocolos e as três atitudes elaboradas por Rogers pode contribuir para a formação acadêmica dos profissionais de saúde e também no estabelecimento de um melhor vínculo entre médico, paciente e familiares.

The way of communicating bad news directly impacts in the treatment adherence of the patient. In light of the difficulties of communicating bad news, protocols were developed to assist the health care professionals in these moments of major vulnerability. This theoretical study aimed to approach the core conditions/attitudes described originally by Carl Rogers in the psychotherapic context to three bad news communication protocols reported from the field specific literature: SPIKES, CLASS and P-A-C-I-E-N-T-E. Diverse steps of these protocols emerge as actions that approximate one moment to congruency/authenticity and another moment to unconditional positive consideration or empathy. It makes licit to affirm that the communication of bad news also approaches to the establishment of a help relation. It can be concluded that this approach between the protocols and the three attitudes developed by Rogers can contribute to the academic training of the health care professionals and also to the better connection between doctor, patient and family.

La forma de comunicar malas noticias impacta directamente en la adhesión al tratamiento por parte del paciente. Frente a las dificultades en comunicar malas noticias, se elaboraron protocolos que auxiliar a los profesionales de salud en esos momentos de mayor vulnerabilidad. Este estudio teórico tuvo por objetivo aproximar las actitudes / condiciones facilitadoras descritas originalmente por Carl Rogers en el contexto psicoterápico con tres protocolos de comunicación de malas noticias a menudo relatados en la literatura del área: SPIKES, CLASS y P-A-C-I-E-N-T-E. Diversas etapas de esos protocolos emergen como acciones que se aproximan a la congruencia / autenticidad, ya la consideración positiva incondicional o de la empatía, haciendo lícito afirmar que la comunicación de malas noticias también posibilita el establecimiento de una relación de ayuda. Se concluye que esta asociación entre los protocolos y las tres actitudes elaboradas por Rogers puede contribuir a la formación académica de los profesionales de la salud y también en el establecimiento de un mejor vínculo entre médico, paciente y familiares.

Da paralisação dos rins ao movimento da vida: percepções de pessoas em tratamento de hemodiálise / From the kidney's paralisation to the life's movement: the perceptions patients of hemodialysis / El cierre de los riñones para el movimiento de la vida: la percepción de las personas en tratamiento de hemodiálises

A insuficiência renal crônica é considerada um grave problema de saúde pública no mundo. Este artigo tem como objetivo conhecer as percepções de pacientes com Doença Renal Crônica (DRC) a partir do seu processo de adoecimento e tratamento. Tem como base para as reflexões o referencial teórico de Carl Rogers, a Abordagem Centrada na Pessoa. Trata-se de uma pesquisa qualitativa, de cunho exploratório e descritivo. O instrumento utilizado foi uma entrevista semi-estruturada, com o uso de um roteiro contendo uma parte destinada a caracterização do participante e outra composta por questões norteadoras. A partir da análise de conteúdo foram criadas quatro categorias: 1) Percepções sobre Doença e Tratamento; 2) Transformações no Modo de Viver; 3) Recursos de Enfrentamento; 4) Mudanças nas Relações. De forma geral, o estudo apontou que além das mudanças na condição física, que resultam na limitação de atividades laborais e de lazer, evidenciam-se mudanças relacionadas ao estado de humor e maneira de relacionar-se no mundo. A dificuldade de integração da doença como parte da vida mostra-se relacionada à dificuldade de atualização do self. Em contrapartida, o potencial de superação mostra-se relacionado à aceitação das limitações e à construção de um significado positivo para o tratamento.

The chronic renal insufficiency is considered a grave problem of public health in the world. This paper has as goal to know the patient's perceptions with chronic renal insufficiency the process of illness and treatment. It has as base the theoretic referential of Carl Rogers, The Person Centered Approach. It is a qualitative research, of exploratory and descriptive nature. The instrument used was a semi-structured interview, with the use of a roadmap containing a part designed to characterize the participant and another composed of guiding questions. From the content analysis it was created four categories: 1) Perceptions of Disease and Treatment; 2) Changes in the Way of Life; 3) Coping Resources; 4) Changes in Relations. Overall, the study found that in addition to changes in the physical condition, resulting in the limitation of labor and leisure activities show up changes related to mood and way of relating to the world. The difficulty of integration of the disease as part of life appears to be related to self-actualization of difficulty before the new condition. In contrast, overcoming potential appears to be related to the acceptance of the limitation and the construction of a positive meaning for the treatment.

La insuficiencia renal crónica se considera un problema grave de salud pública en todo el mundo. Este artículo tiene como objetivo evaluar las percepciones de los pacientes con enfermedad renal crónica (ERC) desde el proceso de su enfermedad y tratamiento. Su base para la reflexión del marco teórico de Carl Rogers, el Enfoque Centrado en la Persona. Se trata de un carácter cualitativo, exploratorio y descriptivo. El instrumento utilizado fue una entrevista semi-estructurada, con el uso de una hoja de ruta que contiene una parte diseñada para caracterizar el participante y otro compuesto por preguntas de orientación. A partir del análisis de contenido que se ha creado cuatro categorías: 1) La percepción de enfermedad y el tratamiento; 2) Los cambios en la forma de vida; 3) recursos de afrontamiento; 4) Los cambios en las relaciones. En general, el estudio encontró que, además de los cambios en la condición física, lo que resulta en la limitación de las actividades laborales y de ocio, se presentó cambios relacionados con el estado de ánimo y la manera de relacionarse con el mundo. La dificultad de la integración de la enfermedad como parte de la vida parece estar relacionada con la auto-realización de dificultad. En contraste, el potencial superación parece estar relacionada a la aceptación de las limitaciones y la construcción de un sentido positivo para el tratamiento.

The promotion of older adults' sense of coherence through Person-Centered Therapy: A randomized controlled pilot study

El objetivo del estudio que se informa fue explorar si una intervención individual de terapia centrada en la persona (TCP) en personas adultas mayores puede promover su sentido de coherencia, en comparación con un grupo control (lista de espera). Se plantea que los participantes asignados al azar a TCP informarían mejoras en SDC de pre y post-intervención en comparación con el grupo control. Un grupo de 87 participantes de 65 a 86 años (M = 72.4; DE = 5.15) fue evaluado con la Escala de Sentido de Coherencia (ESDC) y el cuestionario sociodemográfico en tres momentos diferentes: al inicio del estudio (t1), post-tratamiento (t2) y a los 12 meses de seguimiento (t3). Los resultados indicaron que los participantes en TCP evidenciaron un aumento significativo en cuanto a su SDC (16.7%), mientras que en el grupo control se encontró una disminución significativa (-2.7%), entre el inicio del estudio y el momento de seguimiento. El tamaño del efecto en el grupo TCP fue alto (n²p= .776). En concreto, tanto en la post-intervención como en el momento del seguimiento, los participantes que se sometieron a TCP tenían un SDC significativamente mayor (M = 3.84, DE = .219). Se encontraron diferencias significativas entre el grupo de intervención y el grupo control en la post-intervención y en el seguimiento. Se concluye que los cambios en SDC fueron positivos y mantenidos, por lo tanto, los resultados sugieren que la TCP es favorable a la mejora de SDC. Por otra parte, ya que la SDC se asocia con el bienestar relacionado con la salud de las poblaciones de mayor edad, hay que enfatizar el desarrollo de SDC en la vejez.

Sense of Coherence (SOC) derived from the salutogenic approach and seems to be a health promoting resource, which strengthens resilience and develops a positive subjective state of health. Older adults' SOC is often challenged by specific issues in later adulthood such as grieving for losses, illness, feelings of worthless and solitude, retirement, disability and death, which require distinctive consideration. To our best knowledge, there are no previous studies that indicated the relation between a person-centered therapy (PCT) and older adults' SOC. Therefore, this study aims to explore if a brief eight-session individual PCT intervention on older adults can promote their SOC, as compared with a control group (waiting list). Specifically, this is a randomized controlled pilot study designed to explore the promotion of SOC through an individual-based PCT intervention. We posited that participants randomized to PCT would report improvements in SOC from the pre- to the post-intervention moments when compared to those on the waiting list. The Orientation to Life Questionnaire (OtLQ) and demographics were assessed at the baseline (t1), post-treatment (t2) and at the 12-month follow-up (t3), in a group of 87 participants between 65 - 86 years (M = 72.4; SD = 5.15), from community and health centers in the Great Lisbon area, in Portugal. Participants were mostly women (59.8%), married (65.5%) and professionally inactive (63.2%). The Cronbach's Alpha coefficients for SOCS were .878, .989, and .988, in the three moments, respectively. Inclusion criteria determined their eligibility to participate in the study. No participant with a compromised cognitive function integrated the sample. All potential participants were given a brief description of the study and gave their informed consent. After the baseline assessment, participants were randomly assigned to one of the two groups. The eight-session intervention was conducted in an adequate setting and with a weekly frequency. Comparisons between the three assessments (t1, t2 and t3) for the two groups were done using Repeated Measures ANOVA. Post-hoc Fisher's Least Significant Difference (LSD) test for mean differences was used to compare the three assessments for the SOC, in each group (PCT and waiting list). After the intervention, a significant increase of 17.3% (M = 3.86, SD = .218) was observed in the participants who did the PCT. The SOC evidence dat follow-up (t3) (M = 3.84, SD = .219) by these participants was significantly higher (16.7%) in comparison to the baseline score (M = 3.29, SD = .245). Conversely, participants in the control group experienced a minor decrease between baseline (M = 3.28, SD = .236) and follow-up (M = 3.19, SD = .244) (- 2.7%). The effect size in the PCT group was high (n²p = .776). Significant differences between the intervention group and the control group were found at the post-intervention and follow-up. Findings also showed that participants in PCT experienced an increment in the three dimensions of SOC. The highest increase was observed in the Comprehensibility dimension (71.2%). Manageability and Meaningfulness sub-scales showed an increase of 32.9% and 12.1%, respectively. Changes in SOC were positive and maintained, thus, findings suggest that PCT is favorable to enhancing SOC. In particular, for the participants who did PCT, the significant increase of their SOC was mainly due to the high increase of the comprehensibility of events. This study contributed to filling a gap in gerontological literature and this intervention has the potential to offer a reasonably low-cost self-regulatory approach to the SOC. In this context, PCT is also a personal resource to promote SOC, in late adulthood. Moreover, since SOC is associated with health-related well-being among older populations, SOC development in old age should be stressed.

The promotion of older adults sense of coherence through Person-Centered Therapy: A randomized controlled pilot study

El objetivo del estudio que se informa fue explorar si una intervención individual de terapia centrada en la persona (TCP) en personas adultas mayores puede promover su sentido de coherencia, en comparación con un grupo control (lista de espera). Se plantea que los participantes asignados al azar a TCP informarían mejoras en SDC de pre y post-intervención en comparación con el grupo control. Un grupo de 87 participantes de 65 a 86 años (M = 72.4; DE = 5.15) fue evaluado con la Escala de Sentido de Coherencia (ESDC) y el cuestionario sociodemográfico en tres momentos diferentes: al inicio del estudio (t1), post-tratamiento (t2) y a los 12 meses de seguimiento (t3). Los resultados indicaron que los participantes en TCP evidenciaron un aumento significativo en cuanto a su SDC (16.7%), mientras que en el grupo control se encontró una disminución significativa (-2.7%), entre el inicio del estudio y el momento de seguimiento. El tamaño del efecto en el grupo TCP fue alto (n²p= .776). En concreto, tanto en la post-intervención como en el momento del seguimiento, los participantes que se sometieron a TCP tenían un SDC significativamente mayor (M = 3.84, DE = .219). Se encontraron diferencias significativas entre el grupo de intervención y el grupo control en la post-intervención y en el seguimiento. Se concluye que los cambios en SDC fueron positivos y mantenidos, por lo tanto, los resultados sugieren que la TCP es favorable a la mejora de SDC. Por otra parte, ya que la SDC se asocia con el bienestar relacionado con la salud de las poblaciones de mayor edad, hay que enfatizar el desarrollo de SDC en la vejez.(AU)

Sense of Coherence (SOC) derived from the salutogenic approach and seems to be a health promoting resource, which strengthens resilience and develops a positive subjective state of health. Older adults SOC is often challenged by specific issues in later adulthood such as grieving for losses, illness, feelings of worthless and solitude, retirement, disability and death, which require distinctive consideration. To our best knowledge, there are no previous studies that indicated the relation between a person-centered therapy (PCT) and older adults SOC. Therefore, this study aims to explore if a brief eight-session individual PCT intervention on older adults can promote their SOC, as compared with a control group (waiting list). Specifically, this is a randomized controlled pilot study designed to explore the promotion of SOC through an individual-based PCT intervention. We posited that participants randomized to PCT would report improvements in SOC from the pre- to the post-intervention moments when compared to those on the waiting list. The Orientation to Life Questionnaire (OtLQ) and demographics were assessed at the baseline (t1), post-treatment (t2) and at the 12-month follow-up (t3), in a group of 87 participants between 65 - 86 years (M = 72.4; SD = 5.15), from community and health centers in the Great Lisbon area, in Portugal. Participants were mostly women (59.8%), married (65.5%) and professionally inactive (63.2%). The Cronbachs Alpha coefficients for SOCS were .878, .989, and .988, in the three moments, respectively. Inclusion criteria determined their eligibility to participate in the study. No participant with a compromised cognitive function integrated the sample. All potential participants were given a brief description of the study and gave their informed consent. After the baseline assessment, participants were randomly assigned to one of the two groups. The eight-session intervention was conducted in an adequate setting and with a weekly frequency. Comparisons between the three assessments (t1, t2 and t3) for the two groups were done using Repeated Measures ANOVA. Post-hoc Fishers Least Significant Difference (LSD) test for mean differences was used to compare the three assessments for the SOC, in each group (PCT and waiting list). After the intervention, a significant increase of 17.3% (M = 3.86, SD = .218) was observed in the participants who did the PCT. The SOC evidence dat follow-up (t3) (M = 3.84, SD = .219) by these participants was significantly higher (16.7%) in comparison to the baseline score (M = 3.29, SD = .245). Conversely, participants in the control group experienced a minor decrease between baseline (M = 3.28, SD = .236) and follow-up (M = 3.19, SD = .244) (- 2.7%). The effect size in the PCT group was high (n²p = .776). Significant differences between the intervention group and the control group were found at the post-intervention and follow-up. Findings also showed that participants in PCT experienced an increment in the three dimensions of SOC. The highest increase was observed in the Comprehensibility dimension (71.2%). Manageability and Meaningfulness sub-scales showed an increase of 32.9% and 12.1%, respectively. Changes in SOC were positive and maintained, thus, findings suggest that PCT is favorable to enhancing SOC. In particular, for the participants who did PCT, the significant increase of their SOC was mainly due to the high increase of the comprehensibility of events. This study contributed to filling a gap in gerontological literature and this intervention has the potential to offer a reasonably low-cost self-regulatory approach to the SOC. In this context, PCT is also a personal resource to promote SOC, in late adulthood. Moreover, since SOC is associated with health-related well-being among older populations, SOC development in old age should be stressed.(AU)