Sobre el psicoanálisis y las psicoterapias de orientación psicoanalítica / On Psychoanalysis and Psychoanalytically Oriented Psychotherapies

Ante la presentación del "Plan para la Protección de la Salud frente a las pseudoterapias" del Ministerio de Sanidad, Consumo y Bienestar Social compartimos el necesario objetivo de regular y actualizar la práctica profesional de la Salud Mental tanto en el ámbito público como en el privado, ya que forma parte de la responsabilidad deontológica de nuestras profesiones y en este sentido, también lo es, el realizar una serie de puntualizaciones sobre la consideración del Psicoanálisis, en respuesta a la citada necesidad y a opiniones tópicas que desde hace años se vierten en medios de comunicación, redes sociales y algunos medios profesionales. De acuerdo con esto, aclaramos que el Psicoanálisis actual es una psicología eminentemente centrada en los fenómenos relacionales y que parte de una concepción bio-psico-social del ser humano y, por tanto, está basado en una multicausalidad compleja. Evoluciona continuamente en nuevos modelos que intentan aportar comprensión sobre el funcionamiento humano, así como en nuevas técnicas y formatos de intervención que logran buenos resultados, al menos tan buenos como, y en algunos aspectos, mejores que otros tratamientos basados en la evidencia en psiquiatría

Reacting to the presentation of the "Plan for the Protection of Health Against Pseudotherapies" of the Spanish Ministry of Health, Consumption and Social Welfare, the Spanish Sociey of Psychoanalysis shares the necessary objective of regulating and updating the professional practice of Mental Health both in the public and private spheres , since it is part of the deontological responsibility of our professions. In this sense, we consider that it is also necessary to respond in order to clarify some topical opinions about Psychoanalysis that have been poured into media of communication, social networks and some professional media. The current Psychoanalysis is a Psychology eminently focused on relational phenomena, from a bio-psycho-social conception of the human being in wich therefore, a complex multicausality is assumed. Psychoanalysis continuously evolves in new models that try to provide understanding about human functioning, as well as in new techniques and intervention formats that achieve good results, at least as good as, and in some aspects, better than other evidence-based treatments in Psychiatry

Relationship between the client's adaptive verbalizations and thetherapist's verbal behaviour in the clinic context / La relación entre las verbalizaciones adaptativas del cliente y el comportamiento verbal del terapeuta en el contexto clínico

Today’s clinical psychology advocates for empirically validated treatments. This supports the need for outcome-driven research, but may overlook the importance of process-driven research, which can respond to the question of why psychological treatments work. Functional analysis of behaviour has received a new boost with the emergence of the third wave of psychological therapies, which stress the importance of verbal behaviour in therapy as a way to access and modify client problems. The case presented in this work was analysed in order to make an approach to the strengthening processes that take place in therapy through verbal interaction. First, we developed and applied a categorization system of client’s adaptive verbalizations. We found that this type of verbalizations increase significantly after the first few sessions, remain high in the middle sessions, and gradually decrease towards the end of the therapy. We subsequently developed and used a system of categorization of therapist’s verbal behaviour. We found that agreeable verbalizations were concentrated in the middle sessions, being replaced by other verbalizations in the final sessions

La psicología clínica actual es partidaria de los tratamientos validados empíricamente, lo cual invoca la necesidad de una investigación guiada por los resultados, si bien puede soslayar la importancia de la investigación quiada por los procesos, que puede responder a la pregunta de por qué funcionan los tratamientos psicológicos. El análisis funcional de la conducta ha recibido un nuevo impulso con la emergencia de la tercera ola de terapias psicológicas, que destaca la importancia del comportamiento verbal en la terapia como una manera de acceder a los problemas del cliente y modificarlos. El caso que se presenta en este trabajo nos permitirá acercarnos a los procesos reforzadores que tienen lugar en la terapia debidos a la interacción verbal. En primer lugar hemos desarrollado y aplicado un sistema de caracterización de las verbalizaciones adaptativas del cliente. Observamos que este tipo de verbalizaciones aumenta significativamente transcurridas las primeras sesiones, se mantiene elevado en las sesiones intermedias y disminuye paulatinamente hacia el final de la terapia. Posteriormente elaboramos y utilizamos un sistema de categorización del comportamiento verbal del terapeuta, observando que las verbalizaciones se concentraban en las sesiones intermedias y eran sustituidas por otras verbalizaciones en las sesiones finales

Crisis-repair sequences - considerations on the classification and assessment of breaches in the therapeutic relationship.

BACKGROUND: Recent research indicates that temporary deteriorations of variables monitored continuously in the course of the therapeutic relationship are important characteristics of psychotherapeutic change. These so-called rupture-repair episodes were assessed by different authors using different mathematical methods. METHODS: The study deals with the criteria for identifying rupture-repair episodes that have been established in previous studies. It proposes modifications of these criteria which prospectively could make it possible to identify rupture-repair episodes more precisely and consistently. The authors developed an alternative criterion. This criterion is able to include crisis patterns which had not been considered before, as well as to characterize the length of the crises. As a sample application, the different criteria were applied to continuously measured assessments of the therapeutic interaction in psychodynamic therapy courses (ten shorter processes and one long-term therapy). RESULTS: The analysis revealed that the number of the identified rupture-repair episodes differed depending on the criterion that was used. Considerably more crises were identified with the newly developed criterion. The authors developed a classification of crisis patterns. They distinguished five patterns of crises and their resolution in therapy processes and ascertained the frequency of distribution. The most frequent pattern was the simple V-shape. The second most common pattern was a decline over more than one session with a sudden repair. The longest downward trend comprised a period of six sessions. CONCLUSIONS: The findings of the study give insight into basic mechanisms of change within the therapeutic relationship. A phenomenological discussion of how a crisis is defined is useful to create a methodological approach to the operationalization of crises, to differentiate specific characteristics and to specifically link these characteristics to the outcome in future studies. The methodological deliberations might be applyable to different research areas where the analysis of fluctuations in a variable of interest over time is relevant.

E uno plurus: psychoanalytic psychotherapy in the age of pluralism.

Until 1970 the dominant theoretical framework in American psychoanalysis was Freudian ego psychology. Since then a number of additional theories, such as object relations theory (including, but not restricted to, the Kleinian approach), self psychology, relational psychoanalysis, and attachment theory have evolved and compete with contemporary ego psychology in the current marketplace of psychoanalytic ideas. There is considerable controversy about whether it is advantageous to work from one theoretical model and apply it to all clinical situations, or whether to utilize all the available paradigms, making judgments about which model or combination of them is most useful in a particular clinical situation or at a particular clinical moment. The latter approach might be termed pluralistic. Though a pluralistic approach is not without its philosophic and practical difficulties, such a perspective is helpful in understanding the complexity of human behavior and in facilitating therapeutic growth. A pluralistic approach is familiar to contemporary psychotherapists, who must utilize multiple frameworks in constructing biopsychosocial formulations of their patients. A pluralistic perspective is advantageous in promoting a therapeutic alliance, since it lends itself to a collaborative therapeutic process with patients. A brief clinical vignette is presented to illustrate these ideas.

The psychotherapies.

An outline of Freudian and behavioural psychotherapy is discussed. Various aspects of the techniques of brief psychotherapy and its relevance to modern day psychiatry and general practice is emphasised. Freudian techniques include the exploration of the unconscious childhood conflicts, transference analysis, use of interpretation and working through. Recent revisions to Freudian theories include the object relation approach, therapeutic use of counter-transference and group psychotherapy. Short term dynamic psychotherapy as outlined by Marmour, Mann, Sifneos and Bloom is briefly reviewed. Behavioural psychotherapy, including pavlovian and operant conditioning and Bandura's social learning theory is described. The author also highlights on the recent attempt to integrate supportive psychotherapy within dynamic psychotherapy and the need to modify Western psychotherapy to suit Eastern cultures. The need for cost-containment is likely to shape the type of psychotherapy that will be offered in the future, such as short-term as opposed to long term, group therapy as opposed to individual.