Psychometric properties of the Spanish version of the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM) in Chile.

OBJECTIVE: To examine the psychometric properties of the Spanish version of the 34-item Clinical Outcomes in Routine Evaluation-Outcome Measure questionnaire (CORE-OM). METHOD: Psychometric exploration was conducted in two samples: non-clinical (n = 706) and clinical (n = 420) participants. The non-clinical sample comprised a subgroup of community members (n = 308) and students (n = 398). The clinical sample consisted of self-reported patients (n = 209) and outpatients (n = 211). The analysis included both internal and test-retest reliability, convergent validity, and principal component analysis. A reliable change index and clinical cut-off scores were established for assessing clinically significant change. RESULTS: The Spanish CORE-OM demonstrated good internal consistency and test-retest reliability, along with satisfactory convergent validity against the 45-item Outcome Questionnaire (OQ-45.2). There were strong differentiations between the clinical and non-clinical samples and the four sample subsets. The outpatient group reported the highest scores, while the community group exhibited the lowest scores. There were no marked gender effects. All observed patterns aligned closely with the established Spanish referential data. CONCLUSION: Our findings provide support for the utilization of the Spanish CORE-OM as a measure for tracking psychotherapeutic progress in the context of Chile.

Role of Personality Functioning in the Quality of Life of Patients with Depression.

Depression is associated with reduced quality of life (QoL), and personality pathology is associated with higher impairment and poorer treatment outcomes in patients with depression. This study aims to analyze the effects of personality functioning on the QoL of patients with depression. Severity of depressive symptoms (Beck Depression Inventory), level of personality functioning (Operationalized Psychodynamic Diagnosis Structure Questionnaire), and QoL (Medical Outcome Study 36-item Short-Form) were assessed in a sample of 84 depressive outpatients. Personality functioning showed main effects on both the mental and physical components of QoL. A moderating effect of personality functioning on the relationship between depressive symptoms and QoL was tested but not confirmed. Severity of depressive symptoms was found to mediate the effect of personality functioning on the mental component of QoL. These results suggest that the effect of personality functioning on the QoL of patients with depression may be related to the higher severity of depressive symptoms found in patients with lower levels of personality functioning.

Generic change indicators in therapeutic processes with different outcomes.

OBJECTIVES: This paper analyzes the relationship between ongoing change and final outcome in therapies carried out in natural settings with 39 clients. METHOD: Ongoing change was assessed through generic change indicators (GCIs), an observational method designed to label the content of change moments by selecting one specific GCI from the sequence of 19 that covers from more rudimentary and low complexity to more elaborated and complex changes. These GCIs can also be grouped into three broad stages of change, according to their level of complexity. Productivity indicators were generated to account for the number of GCIs (total and grouped by stage) adjusted by the length of therapy and the respective individual production of GCIs. Outcome, in turn, is understood as the final result of therapy and was measured by Lambert's Outcome Questionnaire (OQ 45.2). RESULTS: Using the Reliable Change Index of this measure, which qualifies the difference between initial and final scores, therapies were grouped into "good outcome" and "poor outcome" cases. Findings indicate that therapies with good final outcome show a greater presence of Stage III GCIs during the process. Furthermore, in these therapies there is a significant association between Stage I GCI productivity and the productivity of Stages II and III GCIs. This is not the case for poor outcome cases, where results show a greater productivity of initial stage GCIs, mostly in the second half of therapy and no relation of this productivity with Stage II and Stage III GCIs. CONCLUSIONS: Results support the relation of ongoing change and final outcome. Possibilities for the clinical use of GCIs, specifically for monitoring ongoing therapies, are discussed.

Psychotherapy research in developing countries: the case of Latin America.

This article describes the state of psychotherapy research in Latin America, a developing region, by means of its scientific production as reflected in international and Latin American publications, as well as through a survey and in-depth interviews with clinicians and researchers from the region. The Latin American publication rate is still low in international journals, which stands in contrast with the high level of publication within the region. The survey reveals an interest in research as well as a limited use of research in clinical practice, while exposing the difficulties of researching and publishing. The in-depth interviews, which cover most of the region, specify Latin America's shortcomings and obstacles to researching, as well as its facilitating factors and comparative advantages. The results are discussed within the framework of the colonizer-colonized relationship, Latin American identity, and the creative integration of developed and developing regions.

Analysis of verbalized emotions in the psychotherapeutic dialogue during change episodes.

As described by many theorists, emotional expressions contribute to the activation and regulation of personal emotional experiences and communicate something about internal states and intentions. These emotional expressions can be observed in the words used in our speech and nonverbal behaviors, even when nonverbal behaviors are synchronized to one's own speech or to the speech of others. Using a quantitative and qualitative methodology, this article reports a classification of verbal emotional expressions of both psychotherapists and patients in change episodes. Assuming that the emotions loaded in linguistic contents are explicit emotions shown by emotion words, this methodology allows for a complete and differentiating assessment of affective qualities in both patients and psychotherapists during the psychotherapeutic dialogue.

Clients', therapists', and observers' agreement on the amount, temporal location, and content of psychotherapeutic change and its relation to outcome.

Clients', therapists', and observers' identification of change was studied in 27 therapeutic processes, and agreement on the amount, temporal location, and content of change was related to outcome. Results show that clients reported more changes in successful therapies. Client-therapist temporal match of change moments was low irrespective of outcome. Results from all three perspectives were consistent in that manifestation of new behaviors and emotions was the most representative content of change among all therapies. Meanwhile, client-therapist agreement on the frequency of grouped change indicators reported was associated with positive outcome, whereas client-observer agreement was related to negative outcome. Therapists and observers agreed in both successful and nonsuccessful therapies. The relationship between agreement and therapeutic outcome is discussed in relation to each dimension of analysis.

Language and therapeutic change: a speech acts analysis.

Drawing on the speech acts theory, a linguistic pattern was identified that could be expected to be associated to therapeutic change, characterized by being uttered in the first person singular and present indicative, and by being self-referential in its propositional content. The frequency of the pattern was examined among verbalizations defined as change moments in three therapies with different theoretical orientation. Results show that the majority of change moments have the specified pattern, and that this pattern is significantly more frequent in change moments than in random non-change-related verbalizations, and so, it does not pertain to therapeutic conversation in general. Implications are discussed concerning the possibility of using the linguistic pattern as an additional and complementary criterion in the identification of moments of change in the therapeutic process.

Beyond Self-Criticism and Dependency: Structural Functioning of Depressive Patients and Its Treatment.

Van Praag states that the underlying psychic dysfunctions in psychopathology must be evaluated (and treated) in patient-centered treatments. In line with this idea, Blatt and colleagues propose the concept of self-critical (introjective) and dependent (anaclitic) functioning. The research program Millennium Initiative has studied self-critical and dependent functioning from different perspectives. The general aim of this paper is to share the results of the program that have contributed to clinical psychotherapeutic thinking. Its first specific aim is to summarize results reported elsewhere that support the predictive value of introjective and anaclitic functioning (Part I), while its second specific aim is to report original data that account for the structural functioning of personality underlying these two constructs (Part II). The results (Part I) show that self-critical functioning is associated with greater reactivity to stress (according to cortisol level in stress tasks) and less subjective awareness of stress, reduced performance in general tasks, and lower mentalization (errors in reading faces); also, patients with introjective (self-critical) depression receiving psychotherapy have more symptoms at onset, higher dropout rates, and poorer response to interventions than anaclitic (dependent) patients. Higher self-criticism was associated with higher depression scores; also, when comparing clinical and nonclinical samples, the latter showed less self-criticism. Therefore, self-critical functioning represents a challenge for researchers and clinicians. The evaluation of the structural functioning of personality showed (Part II) that self-critical functioning is associated with less integrated levels of structure and more depressive symptoms. This functioning is underlain by vulnerabilities in the abilities regulating object relationships and attachments to internal objects. Dependent functioning is associated with vulnerabilities in self-perception, self-regulation, and attachments to external objects. The psychotherapeutic implications of these results are discussed, paying special attention to aspects connected with structure-oriented psychotherapy.

Discussion

In 1992, Sven Olaf Hoffmann, Wolfgang Schneider and Manfred Cierpka, the three psychiatrists, psychoanalysts and psychotherapists, met in a hotel bar to discuss the problem of diagnosis in psychiatry, psychoanalysis, psychosomatics and psychotherapy, thinking that "something had to be done" about it. In the heat of some wine glasses the idea of each of the axes of the OPD arose: prerequisites for treatment, relationship, conflict, structure and descriptive diagnosis. The three colleagues dedicated themselves to the task of bringing together important people from the academic and psychoanalytic scene to construct the first draft of the manual, which by 1995 was already constructed and tested. Subsequently, 120 clinicians were asked to code videotaped interviews with this draft and, after critical feedback, the OPD-1 Manual1 emerged. (AU)

El problema de la distancia con el objeto o el dilema claustro-agorafóbico / The problem of object distance or the claustro-agoraphobic dilemma

El problema de la intimidad y las angustias claustrofóbicas frente al encuentro, así como las agorafóbicas frente al abandono, es un hecho clínico relevante que se da como motivo de consulta y como fenómeno durante el proceso analítico o terapéutico. El presente trabajo aborda esta problemática teórica tomando en cuenta autores franceses, kleinianos y del middle group. Se discute cómo la aparición del síndrome claustroagorafóbico es resultante de la mayor o menor penetrancia de núcleos esquizoides en la estructura de la personalidad del individuo. Finalmente se enfatizan las estimulantes perspectivas que se abren con el estudio empírico de la teoría del apego

Psicofisiología cerebral: La variación contingente negativa y su aplicación en psicología y psicopatología / Cerebral psychophysiology: the contingent negative variation and its application on psychology and psychopathology

Se describe los fenómenos fisiológicos y constructos psicológicosa subyacentes a la Variación Contingente Negativa (CNV), un potencial cerebral lento ligado a eventos mentales. En base a la teoría del "arousal" -atención, se interpretan y discuten resultados obtenido en nuestro laboratorio que demuestran la posibilidad de usar este indicador electrocortical para definir fisiológicamente rasgos psicológicos