RESUMO
In recent years, there has been increasing interest in utilizing time-lagged panel models to study mechanisms of change in psychotherapy. These models offer valuable insights into the dynamic relationships between variables over time and offer stronger causal inference capabilities than cross-sectional analyses. Therefore, they are well-suited for modeling the intricate relationships between mechanisms of change and outcomes in psychotherapy studies, which are typically beyond experimental control. However, their complexity, coupled with the fact that detailed explanations are often embedded in dense statistical or econometric texts, poses challenges. This paper provides a background on cross-lagged panel models and delves deeper into explaining the issues of 1) dynamic panel bias, 2) long-run effects, and 3) testing whether different treatments work by different mechanisms. Using data from a psychotherapy study on treatment of adolescent depression, I demonstrate how these issues manifest in real data. In conclusion, I recommend using structural equation modeling to circumvent dynamic panel bias, reporting long-run effects to reveal the long-term impact of sustained therapeutic work on mechanisms of change, and carefully considering whether mediation, moderation, or a combination of both, best describes differential effects of mechanisms between treatments.
Assuntos
Psicoterapia , Humanos , Psicoterapia/métodos , Modelos Estatísticos , Modelos Psicológicos , Adolescente , Processos PsicoterapêuticosRESUMO
BACKGROUND: Therapeutic and salutogenic effects of psychedelic drugs have been attributed to psychotherapeutic or psychotherapy-like processes that can unfold during the acute psychedelic experience and beyond. Currently, there are no psychometric instruments available to comprehensively assess psychotherapeutic processes (as conceptualized by empirical psychotherapy research) in the context of psychedelic experiences. AIMS: We report the initial validation of the General Change Mechanisms Questionnaire (GCMQ), a self-report instrument designed to measure five empirically established general change mechanisms (GCMs) of psychotherapy-(1) resource activation, (2) therapeutic relationship, (3) problem actuation, (4) clarification, and (5) mastery-in the context of psychedelic experiences. METHODS: An online survey in a sample of 1153 English-speaking and 714 German-speaking psychedelic users was conducted to evaluate simultaneously developed English- and German-language versions of the GCMQ. RESULTS: The theory-based factor structure was confirmed. The five GCMQ scales showed good internal consistency. Evidence for convergent validity with external measures was obtained. Significant associations with different settings and with therapeutic, hedonic, and escapist use motives confirmed the hypothesized context dependence of GCM-related psychedelic experiences. Indicating potential therapeutic effects, the association between cumulative stressful life events and well-being was significantly moderated by resource activation, clarification, and mastery. Factor mixture modeling revealed five distinct profiles of GCM-related psychedelic experiences. CONCLUSION: Initial testing indicates that the GCMQ is a valid and reliable instrument that can be used in future clinical and nonclinical psychedelic research. The five identified profiles of GCM-related experiences may be relevant to clinical uses of psychedelics and psychedelic harm reduction.
Assuntos
Alucinógenos , Psicometria , Humanos , Alucinógenos/uso terapêutico , Adulto , Feminino , Masculino , Inquéritos e Questionários/normas , Adulto Jovem , Pessoa de Meia-Idade , Processos Psicoterapêuticos , Reprodutibilidade dos Testes , Autorrelato , Psicoterapia/métodos , AdolescenteRESUMO
Las personas que enferman expresan en su sufrimiento el desequilibrio de la armonía bio-psicosocial propia de la existencia humana. Por esto, la formación de los nuevos médicos no debe descuidar el sentido universal, integral, que debe tener esa educación superior. Este camino es el único que puede proteger a la profesión médica del riesgo grave de dejar de ser una formación universitaria, es decir abarcativa del todo, para quedar rebajada a la adquisición de conocimientos meramente técnicos que atiendan a una sola de las partes. De predominar lo técnico sobre lo humano, será cada vez más fácil que la Medicina quede a cargo de máquinas inteligentes y el hombre pierda definitivamente contacto con el hombre
"People who get sick suffer the imbalance of the bio-psico-social harmony of human existence. For this reason, the training of new doctors must not neglect the universal, integral sense that that higher education must have. This path is the only one that can protect the medical profession from the serious risk of ceasing to be part of a formal and comprehensive university training, to be reduced to the acquisition of purely technical knowledge that attends to only one of the parties involved. If the technical predominates over the human, it will be increasingly easy for Medicine to be in control of intelligent machines, and man will definitively lose contact with man"
Assuntos
Humanos , Masculino , Feminino , Relações Médico-Paciente , Processos PsicoterapêuticosRESUMO
BACKGROUND: Despite the demonstrated efficacy of psychotherapy, the precise mechanisms that drive therapeutic transformations have posed a challenge and still remain unresolved. Here, we suggest a potential solution to this problem by introducing a framework based on the concept of mental navigation. It refers to our ability to navigate our cognitive space of thoughts, ideas, concepts, and memories, similar to how we navigate physical space. We start by analyzing the neural, cognitive, and experiential constituents intrinsic to mental navigation. Subsequently, we posit that the metaphoric spatial language we employ to articulate introspective experiences (e.g., "unexplored territory" or "going in circles") serves as a robust marker of mental navigation. METHODS: Using large text corpora, we compared the utilization of spatial language between transcripts of psychotherapy sessions (≈ 12 M. words), casual everyday conversations (≈ 12 M. words), and fictional dialogues in movies (≈ 14 M. words). We also examined 110 psychotherapy transcripts qualitatively to discern patterns and dynamics associated with mental navigation. RESULTS: We found a notable increase in the utilization of spatial metaphors during psychotherapy compared to casual everyday dialogues (U = 192.0, p = .001, d = 0.549) and fictional conversations (U = 211, p < .001, d = 0.792). In turn, analyzing the usage of non-spatial metaphors, we did not find significant differences between the three datasets (H = 0.682, p = 0.710). The qualitative analysis highlighted specific examples of mental navigation at play. CONCLUSION: Mental navigation might underlie the psychotherapy process and serve as a robust framework for understanding the transformative changes it brings about.
Assuntos
Idioma , Psicoterapia , Humanos , Comunicação , Metáfora , Processos PsicoterapêuticosRESUMO
OBJECTIVE: The Real Relationship (RR) describes the aspect of the psychotherapy relationship that is based on a genuine connection and a realistic view between patient and therapist. In the current study, we aimed to develop a Psychotherapy Process Q-set (PQS) prototype of the RR to facilitate post-hoc assessment of the RR in psychotherapy session recordings. We also aimed to measure the association between the RR-PQS and current PQS measures of theoretical treatment principles and the working alliance. METHOD: We developed an RR-PQS prototype based on ratings of an ideal RR session by eight RR experts. We assessed the associations between the RR-PQS and existing cognitive behavioral and psychodynamic process prototypes, and seven PQS items known to predict the working alliance. RESULTS: RR experts agreed on the ideal RR session ratings to a high degree (ICC = 0.89). The RR-PQS was moderately related to both cognitive behavioral (r = 0.66, p < 0.01), and psychodynamic prototypes (r = 0.56, p < 0.01). PQS items predictive of the working alliance were characteristic of the RR-PQS. CONCLUSION: The RR-PQS prototype appears to behave in theoretically predicted ways and may be a valid measure of the RR.
Assuntos
Terapia Cognitivo-Comportamental , Psicoterapia Psicodinâmica , Humanos , Terapia Cognitivo-Comportamental/métodos , Psicoterapia Psicodinâmica/métodos , Processos Psicoterapêuticos , Psicoterapia/métodos , Relações Profissional-PacienteRESUMO
The Comparative Psychotherapy Process Scale (CPPS) is a 20-item scale which aims to capture technical features distinguishing cognitive behavioral (CBT) from psychodynamic (PD) psychotherapy (and vice versa) in two corresponding subscales (CBT and PD Subscale). Our objective was to validate a German self-report version of the CPPS regarding a previous psychotherapy session in a psychotherapist- and in a patient-version. Fifty-three psychotherapists and their 53 patients answered to the according German CPPS Scale as well as to specific subscales of the Multitheoretical List of Therapeutic Interventions self-report-instrument (MULTI-30 subscales) assessing CBT- and PD-specific intervention characteristics. We analyzed (a) the correlation of the CPPS with the MULTI-30 subscales, (b) the ability of the CPPS to distinguish whether therapy sessions were either CBT or PD using logistic regression, and (c) the correlation between psychotherapists' and patients' self-report regarding the preceding session (correlation). Both the psychotherapist- and the patient-version showed acceptable to good values of internal consistencies (α = .78-.84). The CBT and PD Subscales of the MULTI-30 correlated with the CPPS subscales in both versions (CBT: rs = .85 [psychotherapist-version] and .80 [patient-version], PD: rs = .79 [both versions]). Subscales correctly discriminated whether the previous session was a CBT or a PD session (correct predictions in 88.7% in the psychotherapist-version, 73.6% in the patient-version; χ² ≥ 14.03, p < .001). The German version of the CPPS is a promising instrument to facilitate research on CBT- and PD-specific psychotherapy processes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Assuntos
Processos Psicoterapêuticos , Psicoterapia Psicodinâmica , Humanos , Psicoterapeutas , AutorrelatoRESUMO
OBJECTIVE: Using patient-generated quantitative data in psychotherapy (feedback) appears to enhance treatment outcome, but there is variability in its effect. Different ways and reasons to implement routine outcome measurement might explain such variability. The goal of this review is to address the insufficient knowledge on how these data are used by therapists and patients. METHODS: The present study is a systematic review and meta-analysis of qualitative reports of therapists' and patients' experiences using patient-generated quantitative data during ongoing psychotherapy. RESULTS: Four main categories of use were identified: (1) uses of patients' self-reported data as nomothetic/objective markers for assessment, process monitoring, and treatment planning; (2) intrapersonal uses that enhance self-awareness, initiate reflection, and influence patients' mood or responses; (3) uses that prompt interactional processes by facilitating communication, supporting exploration, creating ownership in patients, changing treatment focus, enhancing therapeutic alliance, or disturbing the psychotherapy process; and (4) patients responding for specific purposes due to uncertainty and interpersonal motives, or strategic responding to achieve a desired result. CONCLUSION: These results demonstrate that patient-reported data, when used in active psychotherapy, is very clearly not just an objective measurement of client functioning: the inclusion of patient-data has the potential to influence psychotherapy in numerous ways.
Assuntos
Processos Psicoterapêuticos , Aliança Terapêutica , Humanos , Autorrelato , Psicoterapia , Pesquisa QualitativaRESUMO
Objective: The aim of this review is to systematize and interpret results produced over one decade of Psychotherapy Process Research (2009-2019) in eight journals. Method: It is a Mixed Studies Review of quantitative as well as qualitative primary studies. The analysis of the results of these studies included a descriptive quantitative part and a qualitative part that followed the logic of Qualitative Meta Analysis, categorizing the main results of both types of studies in a bottom-up procedure that generates specific content categories that are synthesized in further steps of a higher level of abstraction, leading to an "interpretive synthesis" presented in a narrative way. Results: The review shows that psychotherapy process research uses a variety of qualitative and quantitative methods, often creating new procedures. Furthermore, the review indicates that the most commonly assessed macroprocess variables are ongoing change, therapeutic relationship (predominantly therapeutic alliance), and therapeutic intervention; while the most extensively studied microprocess variables are change events, difficult episodes (mainly ruptures), and therapeutic intervention. Macrolevel results reveal that the main contents of ongoing change are the building of new meanings and progressive psychological integration; underscore the association of the therapeutic alliance with ongoing change and outcome; and show the complexity of associating intervention with outcome, because different phases of therapy (and problems) need different assessments. Microlevel results indicate that change events impact on ongoing change and outcome; that for ruptures the key fact is their repair; and that therapist communication has an immediate influence on patient communication. Conclusion: Our knowledge regarding relevant aspects of psychotherapy is very fragmented; robust and replicated results are still scarce. Only a few variables have been found to consistently predict outcome across most therapies. Only in the field of alliance research it has been possible to perform meta-analyses that clearly demonstrate the impact of this factor on final outcomes. Despite these limitations, psychotherapy process research is a powerful tool for uncovering change mechanisms and is at present widely implemented. Our conclusion is that, in order to generate useful future knowledge, change mechanisms need to be linked to ongoing change; this, in turn, requires models of change, hopefully of a transtheoretical nature.
Assuntos
Processos Psicoterapêuticos , Aliança Terapêutica , Humanos , Psicoterapia , Comunicação , ConhecimentoRESUMO
This study aimed to develop and test algorithms to determine the individual relevance of two psychotherapeutic change processes (i.e., mastery and clarification) for outcome prediction. We measured process and outcome variables in a naturalistic outpatient sample treated with an integrative treatment for a variety of diagnoses (n = 608) during the first 10 sessions. We estimated individual within-patient effects of each therapist-evaluated process of change on patient-evaluated subsequent outcomes on a session-by-session basis. Using patients' baseline characteristics, we trained machine learning algorithms on a randomly selected subsample (n = 407) to predict the effects of patients' process variables on outcome. We subsequently tested the predictive capacity of the best algorithm for each process on a holdout subsample (n = 201). We found significant within-patient effects of therapist perceived mastery and clarification on subsequent outcome. In the holdout subsample, the best-performing algorithms resulted in significant but small-to-medium correlations between the predicted and observed relevance of therapist perceived mastery (r = .18) and clarification (r = .16). Using the algorithms to create criteria for individual recommendations, in the holdout sample, we identified patients for whom mastery (14%) or clarification (18%) were indicated. In the mastery-indicated group, a greater focus on mastery was moderately associated with better outcome (r = .33, d = .70), while in the clarification-indicated group, the focus was not related to outcome (r = -.05, d = .10). Results support the feasibility of performing individual predictions regarding mastery process relevance that can be useful for therapist feedback and treatment recommendations. However, results will need to be replicated with prospective experimental designs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Assuntos
Processos Psicoterapêuticos , Psicoterapia , Humanos , Estudos Prospectivos , Psicoterapia/métodos , Avaliação de Resultados em Cuidados de Saúde , Aprendizado de MáquinaRESUMO
Objectives: In psychotherapeutic change processes, in addition to gradual changes, specific single special moments are described as a starting point for change. We investigated the perception of these moments of change (CMs) from the patient's perspective: What does each patient perceive and experience in a CM? Methods: A qualitative, explorative study of CMs was conducted by means of semi-structured questionnaires as well as qualitative interviews with patients (n = 12). Grounded theory was used for the analysis. Results: CMs were noticed by an "explicit mode of perception" based on physical, emotional and cognitive aspects. In addition, we found a "transcending mode of experience" that involved changes in consciousness and self-experience. CMs showed a "specific transformative pattern" and were preserved as "experience anchors". Conclusions: The intensification of consciousness, transformation of self-experience, and intense prototypical experience of a change process appeared particularly impressive. With the help of CMs, access could be gained to an embodied and implicit experience, which could subsequently be symbolised and used as an "experience anchor". This could be useful especially for the treatment of psychosomatic patients.
Assuntos
Emoções , Processos Psicoterapêuticos , Humanos , Pesquisa Qualitativa , PercepçãoRESUMO
Previous studies show that therapist mood is associated with psychotherapy processes, but the observational nature of these studies does not allow for causal inference. It is also unclear if other therapist characteristics, such as therapist trait empathy, moderate the relation between therapist mood and process variables. Thirty-four therapists and volunteer client dyads participated in three weekly counseling sessions. Before each session, therapists were induced to experience one of three moods, elation, depression, or neutral, in a counterbalanced order, using a combination of music and the Velten method. After each session, clients rated therapist empathy and session quality, therapists rated session quality, and observers rated therapist empathy using videotapes. Electrocardiogram was collected from therapists and clients during the session to assess heart rate synchrony as an indicator of therapist empathy. Therapist trait empathy moderated the effect of mood induction on observer-rated therapist empathy, such that when induced to experience elation, therapists with high trait empathy were observed to be more empathic, whereas therapists with low trait empathy were observed to be less empathic. Therapists of different trait empathy levels did not differ on observer-rated empathy when induced to experience depression or neutral mood. No significant effect of mood induction was found for client-rated empathy, client- and therapist-rated session quality, or heart rate synchrony. The experimental design offers preliminary evidence that therapist presession mood may influence the psychotherapy process. The findings are explained in light of empathy amplification and empathy attenuation hypotheses in relation to positive emotion. Practice and research implications are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Assuntos
Empatia , Psicoterapia , Humanos , Psicoterapia/métodos , Relações Profissional-Paciente , Processos Psicoterapêuticos , AfetoRESUMO
Introduction: Adolescence is a critical period of development during which young people are vulnerable to engaging in risky be haviors, including drug use. Early use of psychoactive substances can interfere with normal development and have both short-term and long-term social and health problems. Objectives: This case report aims to review important aspects of the substance abuse disorder treatment in teenage patients, based on the detailed description of a clinical case. Methods: Description of a clinical case of an 18-year-old patient who began using psychoactive substances at the age of 13. The information used in the review was gathered from relevant publications found through a selective search in PubMed on substance use disorders in children and adolescents. Results: This case report describes the substance use disorder of an 18-year-old female patient, who began using psychoactive substances at the age of 13. The patient had a history off loss of her mother, depressive symptoms and self-injurious behavior, which likely contributed to her increased risk for substance use. The patients substance use began with tobacco and gradually progressed to cannabinoids, ecstasy, opioids, and cocaine. Due to her continued substance use, she was referred for consultation at a specialized treatment team. The patient received a combination of psychotherapeutic interventions for substance use and individual therapy. The plan included also coordination with social work and psychology, and the involvement of the individuals family in the process.Despite these efforts, the patient was ultimately hospitalized for severe self-harm behaviors and entered a therapeutic community.Discussion and Conclusion: This case highlights the complexity of substance use disorders in adolescents and the importance of addressing multiple individual and environmental factors in order...(AU)
Introducción: La adolescencia es un período crítico del desarrollo durante el cual los jóvenes son vulnerables a adoptar conductas de riesgo, incluyendo el consumo de drogas. El uso temprano de sustancias psicoactivas puede interferir con el desarrollo normal y tener problemas sociales y de salud, tanto a corto como a largo plazo.Metas: Este reporte de caso tiene como objetivo revisar aspectos fundamentales del tratamiento del trastorno por abuso de sustancias en pacientes adolescentes, a partir de la descripción detallada de un caso clínico.Métodos: Descripción de un caso clínico de una paciente de 18 años que empezó a consumir sustancias psicoactivas a partir de los 13 años. La información utilizada en esta revisión se obtuvo de publicaciones relevantes encontradas mediante una búsqueda selectiva, en la plataforma PubMed, sobre trastornos por consumo de sustancias en niños y adolescentes.Resultados: Este reporte de caso describe el trastorno por consumo de sustancias de una paciente de sexo femenino de 18 años, que empezó a consumir sustancias psicoactivas a partir de los 13 años. La paciente tenía antecedentes de pérdida de su madre, síntomas depresivos y comportamiento autoagresivo, que probablemente contribuyó a su mayor riesgo de consumo de sustancias. El consumo de sustancias de la paciente empezó con el tabaco y progresó gradualmente a cannabinoides, éxtasis, opioides y cocaína.Debido al consumo continuado de sustancias, fue derivada a consulta, a un equipo de tratamiento especializado. La paciente recibió una combinación de intervenciones psicoterapéuticas para el uso de sustancias y terapia individual. El plan incluía también la coordinación con trabajo social y psicología, y la participación de la familia en el proceso. A pesar de estos esfuerzos, la paciente finalmente fue hospitalizada por conductas autolesivas severas y ingresó a una comunidad terapéutica.(AU)
Assuntos
Humanos , Masculino , Feminino , Adolescente , Transtornos Relacionados ao Uso de Substâncias/psicologia , Consumo de Álcool por Menores , Comportamento de Procura de Droga , Processos Psicoterapêuticos , Comportamento do Adolescente , Depressão , Saúde do Adolescente , Saúde Mental , Psicologia do Adolescente , Psiquiatria , Medicina Psicossomática , Pacientes Internados , Exame FísicoRESUMO
Background and Objectives The study's main aim was to determine which formal aspects of psychotherapy (therapist's work experience, number of sessions held, frequency of meetings, length of sessions) contributed to the quality of the therapeutic (working) alliance. The alliance was also analyzed for demographic variables. Methods The sample consisted of 428 participants, and the working alliance was evaluated in 262 psychotherapistpatient dyads. To assess its quality, the author used the full version of the Working Alliance Inventory (WAI). Results The analyzes led to several conclusions. Their results indicate that the quality of working alliance increases if psychotherapy is conducted by an experienced specialist, if the frequency of sessions is high, and if the sessions are longer. They do not, however, pinpoint the demographic markers of therapeutic alliance quality. Conclusion The formal aspects of the psychotherapeutic process influence the quality of the working alliance. Alliance develops to an equal degree in people of different ages and with diverse levels of education, regardless of the presence or absence of close interpersonal relationships in their lives. (AU)
Assuntos
Humanos , Processos Psicoterapêuticos , Psicoterapia , Aliança Terapêutica , DemografiaRESUMO
Resumen Durante la pandemia por COVID-19 se dio una acelerada virtualización de los procesos de atención psicológica en Costa Rica, en paralelo a la expansión en la regulación de esta modalidad por parte del Colegio de Profesionales en Psicología de Costa Rica. El presente artículo tiene el objetivo de identificar valoraciones de personas del gremio de profesionales en psicología de Costa Rica sobre sus habilidades terapéuticas y técnicas para ejercer psicoterapia clínica individual mediante las Tecnologías de la Información y Comunicación (TIC) durante la Pandemia por COVID-19. Mediante la aplicación de un cuestionario autoadministrado en línea, se realizó un acercamiento al gremio, donde se consultó sobre las estrategias, herramientas y habilidades que puso en práctica para comenzar a utilizar las TIC en su ejercicio psicoterapéutico. Se obtuvieron experiencias muy importantes, aprendizajes sobre la marcha y, sobre todo, la ausencia de un consenso y claridad entre las personas profesionales en psicología sobre las buenas prácticas para el uso de esta modalidad. Como principal reflexión del proceso, se invita al gremio a ejercitar al máximo las habilidades de terapeuta, especialmente aquellas que quizá no resulten empleadas regularmente durante una consulta a distancia, como la observación y el examen clínico integral.
Abstract During the COVID-19 Pandemic, the virtualization of psychological care grew rapidly in Costa Rica, parallel to the expansion of regulation for this modality in the Colegio de Profesionales en Psicología de Costa Rica. The objective of this article is to identify the appraisals of Costa Rican psychology professionals regarding their abilities to practice individual clinical psychotherapy by means of Information and Communication Technologies (ICT) during the COVID-19 Pandemic. Through the completion of a self-administered online questionnaire, professionals were consulted about the strategies, tools and skills that they put into play during the use of ICTs in their psychotherapeutic practice, narrating deeply important experiences, presenting key learnings and above all, making visible the absence of a consensus and clarity regarding the best practices for use in this modality. The main recommendation emanating from this process is to promote to the maximum continuing-education on the topic of therapist skills, especially those that may not be used regularly during a remote consultation, such as observation and comprehensive clinical examination.
Assuntos
Humanos , Masculino , Feminino , Psicologia , Processos Psicoterapêuticos , Educação a Distância , Comunicação por Videoconferência/tendências , Costa Rica , Realidade Virtual , COVID-19RESUMO
This paper, a collaborative effort, describes the work of A Home Within (AHW), a volunteer community-based organization providing pro-bono long term psychotherapy to current and former foster youth. We provide a brief description of the treatment model, present a report of treatment conducted by an AHW volunteer, and discuss further reflections on the societal context of our psychoanalytically-informed work. In-depth psychotherapeutic process from the treatment of a young girl in a pre-adoptive foster placement elucidates the psychotherapeutic possibilities when a psychoanalytic treatment model is accessible to current and former foster youth, usually deprived of this form of treatment due to overburdened, underfunded community mental health systems in the U.S. Open-ended psychotherapy afforded this traumatized child an unusual opportunity to work through past relational traumas in order to form new and more secure attachment relationships. We reflect further on the case from the vantage points of both the psychotherapeutic process and the greater societal context of this community-based program.
Assuntos
Cuidados no Lar de Adoção , Ludoterapia , Criança , Feminino , Adolescente , Humanos , Cuidados no Lar de Adoção/psicologia , Psicoterapia/métodos , Processos PsicoterapêuticosRESUMO
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.
Assuntos
Humanos , Masculino , Feminino , Pacientes , Terapia Comportamental , Processos Psicoterapêuticos , Psicoterapeutas/educação , Relações InterpessoaisRESUMO
OBJECTIVE: The working alliance between therapists and patients is an important factor in the psychotherapy processes. Trait emotional intelligence has also been found to be malleable in treatment and to play a significant role in patient outcomes. The present study investigated how the relationship between measured working alliance and patient symptoms may differ depending on changes in patient trait emotional intelligence capacities. METHODS: One hundred twenty-nine adults at a community mental health clinic completed self-report measures at the beginning of treatment, as well as 8 months into treatment. Hierarchical linear regressions were computed to assess the interaction of working alliance and trait emotional intelligence scores on patient symptom scores. Simple slope tests were used to probe significant interactions. RESULTS: Trait emotional intelligence served as a significant moderator on the relationship between working alliance and patient symptoms. Specifically, the relationship between working alliance and patient symptoms was only significant for participants who reported an improvement in trait emotional intelligence over the course of treatment. CONCLUSION: Results demonstrate that the impact of working alliance on patient symptom outcomes depended on patient improvement in trait emotional intelligence capacities. Such findings emphasize the importance of investigating the nuanced individual factors that impact the ways in which working alliance relates to treatment outcomes.
Assuntos
Relações Profissional-Paciente , Psicoterapia , Adulto , Humanos , Psicoterapia/métodos , Processos Psicoterapêuticos , Resultado do Tratamento , Inteligência EmocionalRESUMO
Antecedentes: identificar subgrupos de pacientes que demuestren diferentes trayectorias de cambio terapéutico durante psicoterapia en contextos realistas es relevante para el desarrollo de procesos terapéuticos personalizados y efectivos. Objetivos: El presente estudio tuvo como objetivos (a) identificar trayectorias de cambios terapéutico en pacientes chilenos (b) explorar variables que puedan predecir la probabilidad de pertenecer a ciertas trayectorias y (c) examinar si estas diferentes trayectorias desembocan en distintos resultados terapéuticos. Método: se llevaron a cabo análisis de modelos de crecimientos mixto (Growth Mixture Modeling - GMM) y regresiones logísticas multinominales en una muestra de 400 pacientes chilenos recibiendo psicoterapia en un centro de salud mental privado. Resultados: se identificaron tres trayectorias de cambio terapéutico (a) disfunción inicial moderada con leve deterioro, (b) disfunción inicial leve con cambio favorable y (c) disfunción inicial severa con rápido cambio favorable. La edad de los pacientes fue considerada un factor predictor de trayectoria significativa, sugiriendo una peor prognosis para pacientes de mayor edad. Además, todas las trayectorias fueron predictoras del resultado terapéutico. Conclusiones: estos resultados pueden ser utilizados para desarrollar intervenciones enfocadas en el paciente, basadas en las trayectorias de cambio que exhiban.
Background: Identifying subgroups of patients that may show distinct trajectories of change during psychotherapy in realistic settings is relevant for the development of personalized therapeutic processes. Aims: The present study sought to (a) identify trajectories of change in Chilean patients; (b) explore variables that may predict the likelihood of belonging to certain trajectories; and (c) examine whether these different trajectories result in differences in treatment outcomes. Method: Growth mixture modeling (GMM) and multinomial logistic regression analysis were carried out on the data of 400 patients receiving psychotherapy at a private outpatient clinic in Chile. Results: Three trajectories of change were identified: (a) moderate initial dysfunction with slight deterioration, (b) mild initial dysfunction with favorable change, and (c) high initial dysfunction with rapid favorable change. Patient's age was found to be a significant predictor of trajectory assigned, suggesting a poorer prognosis for older patients. Moreover, the trajectories were significant predictors of treatment outcome. Conclusions: These results can be used to develop patient-specific therapeutic interventions based on the trajectories they exhibit.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Psicoterapia Breve , Processos Psicoterapêuticos , Chile , Inquéritos e Questionários , Análise de Regressão , Resultado do Tratamento , Assistência AmbulatorialRESUMO
INTRODUCTION: Between-session processes outside the therapy room and beyond the direct interaction between a therapist and client can play an important role in the psychotherapeutic process and outcome. These processes are called intersession experiences and can be seen as internalized mental representations of therapy and/or therapists. Due to the COVID-19 pandemic, different digital forms of treatment have successfully been implemented and could be relevant even after the end of the COVID-19 pandemic. Therefore, patients' internalized mental representations may become highly relevant in the future. RATIONALE: The aim of this study was to conceptually delineate the current state of research on internalized mental representations of therapy or therapists in the period between sessions and to provide an overview of the evidence. In addition, we aimed to identify research gaps to provide a baseline for further research. METHODS: For this purpose, we conducted a scoping review to obtain a comprehensive overview of the evidence and to identify the relevant research gaps. We searched PsycArticles, Medline, PsycINFO, and PSYNDEX for publications on internalized mental representations. RESULTS: The final sample comprised 30 publications published from 1989 to 2021. Based on the individual study results, it can be assumed that intersession experiences are of central importance for psychotherapeutic treatment. However, the scoping review showed that there was a large gap in knowledge in the research of intersession experiences. All previous research was barely comparable, and therefore, a generalized statement is not possible. CONCLUSION: Future research should provide sufficient information about relevant aspects, such as the setting, therapists, and patients, as these factors are likely to have a significant impact on the outcome. Furthermore, better measurements for the assessment of these processes should be developed.
Assuntos
COVID-19 , Pandemias , Humanos , Psicoterapia/métodos , Processos Psicoterapêuticos , Relações Profissional-PacienteRESUMO
Evidence suggests that changes in online psychotherapy adherence factors occurred during the COVID-19 pandemic. Thus, this study aimed to review the perception of patients and psychotherapists regarding factors associated with adherence to online psychotherapy during the pandemic. Thus, 18 articles remained for analysis after searches in five databases and 25 factors associated with adherence to online psychotherapy were identified. The main factors for psychotherapists were confidence in professional skills and connection stability. For the patients, basic informatics skills and finding an adequate setting to participate in sessions. Furthermore, the factors fear of contagion, tiredness and the impossibility of face-to-face meetings emerged during the pandemic. Modifications of factors associated with pre-pandemic adherence were identified and strategies to overcome barriers related to online sessions were presented and discussed. The pandemic has increased adherence to online psychotherapy, although not everyone intends to follow this modality in the post-pandemic. (AU)
Evidências sugerem que ocorreram modificações nos fatores de adesão a psicoterapia online durante a pandemia de COVID-19. Assim, este estudo objetivou revisar a percepção dos pacientes e psicoterapeutas sobre fatores associados a adesão à psicoterapia online durante a pandemia. Restaram 18 artigos para análise após as buscas em cinco bases de dados. Foram identificados 25 fatores associados a adesão a psicoterapia on-line. Para os psicoterapeutas, os principais fatores foram a confiança nas habilidades profissionais e estabilidade da conexão. Para os pacientes, foram o conhecimento básico de informática e encontrar setting adequado para participar das sessões. Ademais, os fatores medo do contágio, cansaço e a impossibilidade de reuniões presenciais surgiram durante a pandemia. Modificações em fatores associados a adesão pré-pandemia foram identificadas e estratégias para contornar barreiras relacionadas aos atendimentos on-line foram apresentadas e discutidas. A pandemia aumentou a adesão a psicoterapia on-line, mas nem todos pretendem seguir nessa modalidade no pós-pandemia. (AU)
Evidencias sugieren que se produjeron cambios en los factores de adherencia a la psicoterapia en línea durante la pandemia del COVID-19. Por lo tanto, este estudio busca revisar las percepciones de pacientes y psicoterapeutas sobre los factores asociados a la adherencia a la psicoterapia en línea durante la pandemia. Se analizaron 18 artículos seleccionados tras una búsqueda en cinco bases de datos. Se identificaron 25 factores de la adherencia a la psicoterapia en línea. Para los psicoterapeutas, los principales factores fueron la confianza en las competencias profesionales y la estabilidad de la conexión. Ya para los pacientes, los factores básicos fueron las habilidades informáticas básicas y la búsqueda del entorno adecuado para participar en las sesiones. Además, durante la pandemia surgieron los factores miedo al contagio, cansancio y la imposibilidad de encuentros físicos. Se identificaron modificaciones en los factores asociados a adherencia prepandémica y se presentaron y discutieron estrategias para superar las barreras relacionadas con las sesiones en línea. La pandemia aumentó la adhesión a la psicoterapia en línea, aunque no todos tengan la intención de seguir esta modalidad en la pospandemia. (AU)