La reorganización de un servicio comunitario de salud mental infantil y juvenil ante la pandemia de covid-19 / The reorganization of a community mental health center for children and youth due to the covid-19 pandemic

La crisis sanitaria causada por la COVID-19 ha forzado una reorganización de los servicios de salud mental. El presente artículo describe una propuesta de reorganización aplicada en una unidad de salud mental infanto-juvenil (atención ambulatoria y comunitaria). Se exponen las estrategias concretas de intervención desarrolladas en las distintas fases de la pandemia según las medidas de restricción sanitarias y los distintos niveles de intervención requeridos (prevención, atención primaria y atención especializada). Además, se compara el número de visitas hechas durante el periodo de Marzo-Julio de 2020 con el mismo periodo en 2019. Concluimos que se ha producido una rápida adaptación del marco asistencial presencial a la metodología telemática mediante una reorganización flexible. Sin embargo, la disminución de la asistencia presencial y la cancelación de grupos terapéuticos han incrementado la presión asistencial notablemente. Se ha observado un incremento de conductas autolíticas y de problemas relacionados con la conducta alimentaria que deberán ser investigados en futuros estudios. (AU)

The heath crisis caused by COVID-19 has required a reorganization of mental health centers. This article describes the reorganization proposal that was applied in a child and adolescent mental health unit (outpatient and community care). The specific intervention strategies developed in the different phases of the pandemic are presented according to the sanitary restriction measures and the different levels of intervention required (prevention, primary care, and specialized care). In addition, the number of visits made during March-July 2020 is compared to the same period in 2019. We conclude that there has been a rapid adaptation from the face-to-face care framework to atelematic approach through a flexible reorganization. However, the decrease in face-to-face assistance and the cancellation of therapeutic groups have significantly increased the pressure of care. A rise in autolytic behaviors and eating pathologies has been observed that should be investigated in future studies. (AU)

Psicología Clínica en Atención Primaria: la experiencia en Asturias / Clinical Psychologist in Primary Care: the work carried out in Asturias

OBJETIVO: Describir las características de la población atendida en el programa de psicología clínica en Atención Primaria, así como realizar un análisis preliminar de los resultados obtenidos. MÉTODO: Estudio descriptivo prospectivo de los resultados obtenidos tras intervención psicológica breve. Se utilizaron los instrumentos de evaluación PHQ-9, GAD-7, WHOQOL-BREF y un cuestionario de satisfacción diseñado ad hoc. RESULTADOS: Se derivaron al programa 1.084 pacientes, en su mayoría mujeres. Los diagnósticos más frecuentes fueron ansiedad, trastornos adaptativos, códigosZ (factores que influyen en el estado de salud y contacto con los servicios de salud) y trastornos depresivos. El tiempo de espera medio se sitúa en 7,25 días, y el número medio de consultas, en 3. En la comparación al inicio y tras la finalización del tratamiento se encontró una mejora estadísticamente significativa en todas las variables evaluadas, así como una alta satisfacción y utilidad del tratamiento. CONCLUSIONES: La integración del psicólogo clínico en Atención Primaria supone una mejora en la calidad asistencial de los pacientes con alteraciones emocionales, facilitando un abordaje interdisciplinar bio-psico-social y ofreciendo tratamientos e intervenciones basadas en la evidencia y recomendadas internacionalmente

AIM: To describe the characteristics of the population attended in the clinical psychology programme in Primary Care, as well as to perform a preliminary analysis of the results obtained. METHOD: Prospective, descriptive study of the results obtained after brief psychological intervention. The following evaluation tools were used: PHQ-9, GAD-7, WHOQOL-BREF, and an ad hoc designed satisfaction questionnaire. RESULTS: A total of 1084 patients were referred to the program, and were mostly women. The most frequent diagnoses were anxiety, adaptive disorders, Zcodes (factors that influence the state of health and contact with health services) and depressive disorders. The mean waiting list time was 7.25 days, and the mean number of consultations was3. The analyses performed after the treatment showed an improvement in all the variables evaluated, as well as high satisfaction and usefulness of the treatment. CONCLUSIONS: The integration of the clinical psychologist in Primary Care leads to an improvement in the quality of care of patients with emotional disorders, facilitating an interdisciplinary bio-psycho-social approach, and offering internationally recommended evidence-based treatments and interventions

Estado actual sobre la opinión e implantación en la sociedad de los psicólogos en España / Current status on the opinion and implantation in society of psychologists in Spain

Existen pocos estudios que presenten la imagen de la profesión de psicología en el contexto español. Este estudio de tipo descriptivo y correlacional tiene como objetivo describir el estado actual de la opinión que existe en la sociedad española. Se obtiene una muestra de 920 personas de forma incidental utilizando como instrumento un cuestionario específico. Se realiza un análisis descriptivo de las respuestas que generan un patrón global y se hace un agrupamiento por clúster, que divide a la muestra en cuatro perfiles específicos de respuestas. Los principales resultados indican que las opiniones son en general positivas, aunque todavía existen algunos mitos y visiones más tradicionales que se observan en algunos clústers, por lo que se ha de seguir trabajando en aumentar y difundir el conocimiento de la sociedad en relación con la profesión

There are few studies that present the image of the profession of psychology in the Spanish context. This descriptive and correlational study aims to describe the current state of opinion about psychology that exists in Spanish society. An incidental sample of 920 were surveyed. A descriptive analysis of the responses that generate a global pattern is carried out. Also a cluster analysis which divides the sample into four specific response profiles was performed. The main results indicate that opinions are generally positive, although there are still some myths and more traditional visions that are observed in some clusters, so work should continues to increase and spread the knowledge of society in relation to the profesión

[Clinical Psychologist in Primary Care: The work carried out in Asturias]. / Psicología Clínica en Atención Primaria: la experiencia en Asturias.

AIM: To describe the characteristics of the population attended in the clinical psychology programme in Primary Care, as well as to perform a preliminary analysis of the results obtained. METHOD: Prospective, descriptive study of the results obtained after brief psychological intervention. The following evaluation tools were used: PHQ-9, GAD-7, WHOQOL-BREF, and an ad hoc designed satisfaction questionnaire. RESULTS: A total of 1084 patients were referred to the program, and were mostly women. The most frequent diagnoses were anxiety, adaptive disorders, Zcodes (factors that influence the state of health and contact with health services) and depressive disorders. The mean waiting list time was 7.25days, and the mean number of consultations was3. The analyses performed after the treatment showed an improvement in all the variables evaluated, as well as high satisfaction and usefulness of the treatment. CONCLUSIONS: The integration of the clinical psychologist in Primary Care leads to an improvement in the quality of care of patients with emotional disorders, facilitating an interdisciplinary bio-psycho-social approach, and offering internationally recommended evidence-based treatments and interventions.

Influence of experience on the thought process of clinical psychologists: an analysis from the dual-process theories framework

In the course of their work, psychologists must make judgments and complex decisions, skills that are part of clinical reasoning. Recent models approach the analysis of such process using the dual-process theories framework. This study provides an assessment of the two systems, System 1 and System 2, in forty-five clinical psychologists with different levels of experience (novices, intermediates and experts) with the purpose of exploring their level of activation and evolution throughout such stages of expertise. According to the results, clinical psychologists mainly activate System 2, M = 70.91, SD = 6.71, than System 1, M = 60.49, SD = 3.78; when performing their clinical duties. However, no significant changes have been observed regarding the preferential use of thinking Systems 1 or 2 throughout the experience, both systems are used in a similar way in the different levels of expertise analyzed, with an increase of System 2 at the intermediate level of expertise. The results are analyzed in terms of intermediate effect and discussed focusing on the unremitting need for System 2 in psychologist work given the idiosyncratic characteristics of each case requiring treatment in the area of psychology and on the relationship of the two systems in clinical reasoning

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Empirical research in clinical supervision: a systematic review and suggestions for future studies.

BACKGROUND: Although clinical supervision is considered to be a major component of the development and maintenance of psychotherapeutic competencies, and despite an increase in supervision research, the empirical evidence on the topic remains sparse. METHODS: Because most previous reviews lack methodological rigor, we aimed to review the status and quality of the empirical literature on clinical supervision, and to provide suggestions for future research. MEDLINE, PsycInfo and the Web of Science Core Collection were searched and the review was conducted according to current guidelines. From the review results, we derived suggestions for future research on clinical supervision. RESULTS: The systematic literature search identified 19 publications from 15 empirical studies. Taking into account the review results, the following suggestions for further research emerged: Supervision research would benefit from proper descriptions of how studies are conducted according to current guidelines, more methodologically rigorous empirical studies, the investigation of active supervision interventions, from taking diverse outcome domains into account, and from investigating supervision from a meta-theoretical perspective. CONCLUSIONS: In all, the systematic review supported the notion that supervision research often lags behind psychotherapy research in general. Still, the results offer detailed starting points for further supervision research. TRIAL REGISTRATION: PROSPERO; CRD42017072606 , registered on June 20, 2017.

Calidad de las historias clínicas de los practicantes de un consultorio psicológico de una universidad colombiana / Quality of the clinical notes of internship students in a psychology clinic of a Colombian university

INTRODUCCIÓN: Las prácticas académicas en los programas de psicología en Colombia constituyen una parte fundamental del currículo. Los consultorios psicológicos universitarios son un escenario en el cual se desarrolla esta actividad en el campo de la psicología clínica, por lo que se hace necesario revisar la información que se recauda allí, con vistas a supervisar la calidad de dichas prácticas. MÉTODO: Estudio exploratorio retrospectivo en el cual se analizaron los motivos de consulta, los diagnósticos, las estrategias de evaluación e intervención, las metas terapéuticas y los datos sociodemográficos de 708 historias clínicas diligenciadas entre 1999 y 2012 por estudiantes de últimos semestres en periodo de prácticas en una universidad colombiana. RESULTADOS: Se encontró que los diagnósticos están referidos en su mayoría a estresores psicosociales, más que a psicopatologías, y tanto las herramientas de diagnóstico como las estrategias de intervención no son coherentes con el diagnóstico registrado en la historia clínica. CONCLUSIONES: Es evidente la necesidad de fortalecer la formación básica en psicología clínica, en cuanto a sus métodos y alcances, de forma que se brinde una atención a los usuarios que tenga bases científicas, así como establecer protocolos de control para la supervisión de estudiantes en prácticas clínicas en la formación de pregrado

INTRODUCTION: Academic internships in psychology programs in Colombia are a fundamental part of the curriculum. University Psychological Services are a scenario in which this activity is developed in the field of clinical psychology, making it necessary to review the information collected there in order to monitor the quality of such practices. METHOD: A retrospective exploratory study in which the reasons for consultation, diagnoses, strategies of evaluation and intervention, therapeutic goals and sociodemographic data of 708 medical records were analysed, between 1999 and 2012, by students in the final semesters of the internship period in a Colombian university. RESULTS: It was found that the diagnoses mostly referred to psychosocial stressors rather than psychopathologies. The diagnostic tools and intervention strategies are not consistent with the diagnosis recorded in the clinical notes. CONCLUSIONS: The need to strengthen basic training in clinical psychology is evident, in terms of its methods and scope, in order to provide users with a scientific basis, as well as to establish control protocols for the supervision of students in Clinical internships in undergraduate training

[The clinical psychologist in health centres. A joint work between primary care and mental health]. / El psicólogo clínico en los centros de salud. Un trabajo conjunto entre atención primaria y salud mental.

From the model of Integral Primary Care and under the principle of continuity of care, the development of channels of communication and integration between the first and second level of care in relation to mental health care is proposed. It presents the pioneering experience established in the Health Service of Lanzarote in which the figure of the clinical psychologist has been moved to the Health Centres to develop a joint community program from the Primary Care. The lines of action have focused on direct work with the patient, as well as with the staff, both individually and as a group. The objective is the sensitisation and standardisation of the treatment for mental disease in Health Centres. This work has been carried out with a positive assessment by patients and staff of the centres, which at the same time has demanded greater accessibility for a full implementation of the joint work model focused on the promotion, prevention, detection, and treatment for health mental.

Neuropsychology and clinical health psychology in the UK Ministry of Defence.

Neuropsychological testing has been used in a wide range of applications across military settings, including the selection of personnel to engage in covert operations, battlefield assessment and rehabilitation following blast exposure, traumatic brain injury, other neurological conditions and assessment of malingering. Over recent decades, military psychologists have helped to shape the advances in assessing and remediating the psychological sequela that is associated with operationally related neurological and other physical injuries. This paper will present an overview of some of the neuropsychological and related services within the UK Armed Forces, which are provided to service personnel with traumatic brain and other physical injuries.

Leadership in 21st century military healthcare: what did clinical psychologists ever do for us?

Psychology is integral to the concepts and practice of leadership. Leadership models often have their roots in psychological paradigms, making it intrinsically easy for psychologists to grasp and apply them alongside clinical models. Psychologists' 'second-order' skills have been used to good effect in the changing landscape of military mental healthcare: modelling adaptive responses to change, understanding the non-conscious aspects of relationships in hierarchical organisations, working with systems, the ability to diagnose situational requirements and act accordingly, drawing on a range of psychological theories and leadership styles. The clinical psychologist as a professional who can help others 'reframe' a situation or experience is key to their leadership role within healthcare settings, 'enabling others to achieve shared purpose in the face of uncertainty'. The contribution that clinical psychology has made to leadership in Defence over the past 20 years will be illustrated by personal accounts from 'experts by experience'.

Una Extensión del Concepto de Regla y su Aplicación a la Terapia Psicológica / An extension of the concept of rule and its application to therapy

Proporcionar y seguir reglas se ha considerado un factor importante en la eficacia de los tratamientos psicológicos; sin embargo, hace falta una clarificación conceptual de lo que se entiende por emitir o seguir una regla y su aplicación en el ámbito clínico. Partiendo de una revisión sobre el concepto original de conducta gobernada por reglas, nuestro propósito fue extender la definición de esta conducta orientada al proceso terapéutico. Esta definición permite su identificación y estudio momento a momento a lo largo del proceso. La extensión de esta definición puede ayudarnos a identificar el papel funcional de las reglas en el cambio terapéutico y las variables involucradas que contribuyen al entendimiento de fenómenos clínicos como la generalización. Los hallazgos que se desprendan del estudio de las reglas desde esta perspectiva podrían contribuir a aumentar la información sobre el proceso de cambio terapéutico y la mejora del ejercicio clínico

Providing and following rules has been considered an important factor in the effectiveness of psychological treatments; however, a conceptual clarification is needed of what is meant by issuing or following a rule and its application in the clinical setting. Based on a review of the original concept of rule-governed behavior, our purpose was to extend the definition of this behavior oriented to the clinical process. This definition allows its identification and study moment by moment throughout the therapeutic process. The extension of this definition can help us to identify the al role of rules in clinical change and the variables involved that contribute to the understanding of clinical phenomena such as generalization. The findings that emerge from the study of rules from this perspective could increase the information on the therapeutic change process and, therefore, contribute to the improvement of clinical practice

Evaluation of professional supervision in Aotearoa/New Zealand: An interprofessional study.

The evaluation of professional supervision has been a focus for discussion in the supervision literature over past decades. A review of the literature in this area, however, suggests that evaluation has been differently defined, variously addressed, and a range of outcomes reported. The present study reports the findings of the first stage of a three-stage study of evaluation in professional supervision in Aotearoa/New Zealand. Experienced practitioners from the four professions of counselling, mental health nursing, psychology, and social work were interviewed to explore how evaluation in professional supervision is understood and actioned in practice. Twenty four semistructured interviews were conducted with supervisees, supervisors, and managers from each of the identified professions. The findings from these interviews indicate that a majority of participants applied some form of evaluation to their supervision arrangement. These evaluations, however, did not reflect an overarching organizational or professional culture of formal evaluation, but rather, an individualized ad-hoc process initiated by one or both of the participants (supervisor and supervisee). These evaluations focussed predominantly on the process, rather than the outcomes, of supervision. While many respondents expressed interest in a formal process for evaluating supervision, a number of concerns were also raised. These concerns included a lack of evaluation skills and resource, the potential for formal evaluation to have a negative impact on the supervision relationship, the importance of maintaining the boundaries of confidentiality, and a wariness regarding the possible use of any information gathered.

Psychooncology in Poland. / Psychoonkologia w Polsce.

Psycho-oncology is an interdisciplinary field of medicine that deals with the psychological aspects of cancer. Psycho-oncology is a sub-discipline of clinical oncology, psychiatry, clinical psychology and health psychology. It was formally established in 1975. In Poland, the Polish Psycho-Oncology Association deals with the issues of psycho-oncology since 1992. Despite the dynamic development of psycho-oncology, in Poland psychological help for people with cancer covered under the health insurance is not sufficient. The main tasks facing the Polish psycho-oncology is: to define psycho-oncologist profession and to make it administratively independent profession, to identify psycho-oncological benefits under the health insurance and to determine standards of psycho-oncological care in the National Program of Cancer Prevention.

Cultivating Community Psychology for Future Generations: Symbiosis, Synergy, and Separation.

As we near the fiftieth anniversary of the founding of a community psychology division of the American Psychological Association, there are reasons to be concerned about the sustainability of the field. This commentary proposes a need for deliberate, systematic efforts to cultivate settings that can sustain the field. A framework for outreach to build symbiotic relationships and synergistic collaborations with persons who do not identify as community psychologists is proposed. Simultaneously, a strategy of separation from other disciplines may be needed in some circumstances to conserve settings that sustain the field. Finding a balance in these strategies is necessary to cultivate community psychology for future generations.

Capturing Psychologists' Work in Integrated Care: Measuring and Documenting Administrative Outcomes.

With the expansion of integrated primary care and the increased focus on fiscal sustainability, it is critical for clinical managers of these innovative systems to have practical methods for measuring administrative outcomes. Administrative outcomes will assist leadership in the development of efficient, streamlined clinics to provide services to the primary care population. Additionally, administrative measures can be utilized to provide information to assist in guiding resource utilization and management decisions. Several administrative outcomes are suggested for integrated primary care managers to consider for application, including: clinic utilization measures, integrated care administrative measures, wait time and access metrics, and productivity monitors. Effective utilization of these measures can help office managers and clinic leadership not only to maximize patient care, but also to enhance essential business operations, which increase the long-term sustainability of integrated primary care programs.

Una forma de dependencia emocional: El "síndrome de Fortunata" / The "Fortunata syndrome": a form of emotional dependency

El artículo presenta información sobre una modalidad de dependencia emocional –para la que se acuña el término 'Síndrome de Fortunata'- que designa un tipo de relaciones afectivas que determinadas mujeres desarrollan repetidamente hacia hombres casados. En el síndrome son identificables varios patrones de conducta y varias actitudes características, como la fuerte y duradera dependencia emocional y la fidelidad hacia ese hombre, la ambivalencia de sentimientos hacia la pareja oficial (rencor por la creencia de que le ha arrebatado algo propio, pero también deseos de ser ella, de emularla o, incluso, de llevarse bien), el cuestionamiento de la validez de la unión del hombre con la otra mujer y la fantasía reiterada de que las circunstancias cambiarán y ambos acabarán juntos. Además de delimitar e ilustrar este tipo de relaciones, sus peculiaridades y sus diferencias respecto de otras situaciones con las que podría confundirse, se hipotetizan algunas posibles causas de esta forma de dependencia emocional y se presentan varias estrategias para ayudar a las mujeres que quieren terminar con esta modalidad de vinculación afectiva

This paper presents information about a form of emotional dependency, for which the term 'Fortunata syndrome' has been coined, designating a type of affective relationship that some women develop repeatedly with married men. Several patterns of behaviour and repeated attitudes can be identified in this syndrome, such us the strong and lasting emotional dependency and loyalty to the man, the ambivalence of feelings towards the official partner (resentment due to the belief that the partner has taken something which belongs to them, but also the desire to be her, to imitate her or even to get along with her), the questioning of the validity of the union of man with the other woman and repeated fantasies that their circumstances will change and they will end up together. In addition to defining and illustrating these relationships, their idiosyncrasies and their differences with regards to other situations with which they could be confused, we hypothesise some possible causes of this form of emotional dependence and we present several strategies to help women who wish to put an end to this form of affective linkage

Psicología Clínica en Atención Primaria: descripción de un año de asistencia / Clinical Psychology in Primary Care: a descriptive study of one year of operation

Objetivo. El estudio del funcionamiento de la asistencia en un dispositivo ambulatorio de Psicología clínica de Atención Primaria en su primer año de puesta en marcha. Material y método. Estudio descriptivo-prospectivo, en el que se analiza la demanda y labor asistencial del dispositivo, con el que colaboraron 36 médicos de familia (33% del total de profesionales del área), pertenecientes a 6 centros de salud, durante un año, al que fueron enviados 171 pacientes, de 15 años y mayores con trastornos psicológicos leves (> 61 en la escala de evaluación global, APA, 2002). Resultados. Ciento once pacientes recibieron tratamiento, fundamentalmente con diagnósticos de: trastorno de adaptación, afectivo y ansiedad, el 54,82% alcanzaron el alta y al año de la intervención se había producido una disminución global en cuanto al uso de medicación de un 25,19%. Conclusiones. El dispositivo de Psicología clínica de Atención Primaria es una unidad intermedia entre los médicos de Atención Primaria y las unidades especializadas por lo que se atiende sintomatología menos grave y menos definida que en las Unidades de Salud Mental y que supone un apoyo y una descarga importante para estos. Para los pacientes supone una intervención temprana que evita la cronificación de sus síntomas así como un menor consumo de psicofármacos, a un año vista. Pese a la moderada concordancia entre los diagnósticos de los médicos y del dispositivo, se ha establecido una vía de comunicación y trabajo interdisciplinar directo e inmediato, que será necesario implementar y que supone un ahorro de recursos y sufrimiento (AU)

Objective. Our aim is to present the first year of operation of a Clinical Psychology service in a Primary Care setting. Material and method. A descriptive study was performed by analysing the requests and the care intervention of the Psychology Service, in collaboration with 36 general practitioners (33% of the staff), belonging to 6 health centres. Within the one year period, 171 outpatients from 15 years and older were referred with mild psychological disorders (> 61 in the global assessment functioning scale, APA, 2002). Results. A total of 111 outpatients received psychological care. The main diagnoses were adaptation disorder, affective disorder, and anxiety. More than half (54.82%) of them achieved a full recovery. After a year follow up, a drop of 25.19% was observed in medicines use. Conclusions. The Primary Care Psychology team is a halfway unit between Primary Care practitioners and specialised units in order to deal with mild mental symptomatology which otherwise could be undertreated. It represents an important support for practitioners. Secondly, the early intervention can prevent mental problems becoming chronic, as shown by the drop in medication use. In spite of the not very high agreement between the practitioner's diagnoses and those made by the Psychology unit, it has set up an important means of communication and with direct and immediate interdisciplinary action. This should eventually lead to savings in economic resources and human suffering (AU)

Resilient Systemics to Telehealth Support for Clinical Psychiatry and Psychology.

Reliably expanding our clinical practice and lowering our overhead with telepsychiatry, telepsychology, distance counseling and online therapy, requires resilient and antifragile system and tools. When utilized appropriately these technologies may provide greater access to needed services to include more reliable treatment, consultation, supervision, and training. The wise and proper use of technology is fundamental to create and boost outstanding social results. We present, as an example, the main steps to achieve application resilience and antifragility at system level, for diagnostic and therapeutic telepractice and telehealth support, devoted to psychiatry and psychology application. This article presents a number of innovations that can take psychotherapy treatment, supervision, training, and research forward, towards increased effectiveness application.