Distance supervision in the Aiglé Foundation's Latin American Psychotherapy Training Program.

Latin American literature on clinical supervision is limited and literature concerning technology-assisted supervision is virtually nonexistent. We address this gap, providing our perspective on the use of technology in distance supervision within Argentina and Guatemala. Despite important differences, these two countries share many sociocultural features. We contextualize these perspectives, describing therapist training according to the Integrative Model of Fundación Aiglé. Through the use of vignettes, we illustrate contextualized training experiences, concluding with a synthesis of strengths and weaknesses encountered when implementing the use of technology in distance supervision.

Reflections on supervision in psychotherapy.

The aim of the author is to share his reflections on supervision as a central topic in therapists' education and training programs. The concept of supervision, its functions and effects on the training process along with the contributions of different theoretical models to its evolution are addressed. Supervision alliance, the roles of supervisor and supervisee, evaluation as a central component and the influence of socioeconomic factors are discussed. The conclusions depict the most interesting paths for development in the near future and the areas where research needs to be further conducted along with the subjects most worthy of efforts in the supervision field.

Bridging the gap between research and practice in a clinical and training network: Aigle's program.

The aim of this article is to share our experience at the Aiglé Foundation in fostering research that can conducted by (or in collaboration with) clinicians within a specific type of naturalistic setting-one that not only provides psychological services but also trains psychotherapists. After presenting the structure of Aiglé and the implementation of its scientific-practitioner philosophy, we describe some of the research that has been conducted with our network of clinicians and the benefits of connecting clinical practice and academic work. We then discuss some of the obstacles that we have encountered in conducting such studies, as well as a number of strategies that we adopted in attempting to address these challenges. We end this article by briefly describing the current state of our practice-research network, and by offering some recommendations to facilitate the conduct of research by and for clinicians.

Maladaptive Consequences of Mental Intrusions with Obsessive, Dysmorphic, Hypochondriac, and Eating-disorders Related Contents: Cross-cultural Differences.

BACKGROUND/OBJECTIVE: Unwanted mental intrusions (UMIs) with contents related to Obsessive-Compulsive Disorder (OCD), Body Dysmorphic Disorder (BDD), Illness Anxiety Disorder (IAD), and Eating Disorders (EDs) are highly prevalent, independently of the cultural and/or social context. Cognitive-behavioral explanations for these disorders postulates that the escalation from common UMIs to clinically relevant symptoms depends on the maladaptive consequences (i.e., emotions, appraisals, and control strategies) of experiencing UMIs. This study examines, from a cross-cultural perspective, the cognitive-behavioral postulates of the maladaptive consequences of having UMIs. METHOD: Non-clinical 1,473 participants from Europe, the Middle-East, and South America completed the Questionnaire of Unpleasant Intrusive Thoughts to assess the maladaptive consequences of experiencing highly disturbing OCD, BDD, IAD, and EDs-related UMIs. RESULTS: Findings revealed main effects for both the country and the consequences associated with the four UMI contents. Interaction effects between the consequences of each UMI content and the sample location were also observed. CONCLUSIONS: Cognitive-Behavioral models for OCD, BDD, IAD, and EDs should be implemented along with socio-cultural variables that increase the understanding of the role of these variables in the phenomenology of UMIs and their associated consequences.

INTRODUCCIÓN/OBJETIVO: Las intrusiones mentales no deseadas (IM) de contenidos relacionados con el Trastorno Obsesivo-Compulsivo (TOC), el Trastorno Dismórfico Corporal (TDC), la Ansiedad por la Enfermedad (AE), y los Trastornos Alimentarios (TAs) son muy prevalentes, independientemente de la cultura y/o el contexto social. Las explicaciones cognitivo-conductuales de esos trastornos postulan que la escalada de IM normales a síntomas clínicamente relevantes depende de las consecuencias desadaptativas (i.e., emociones, valoraciones y estrategias de control) de las IM. Este estudio examina los planteamientos sobre dichas consecuencias desde una perspectiva transcultural. MÉTODO: 1.473 participantes de Europa, Oriente Medio y Suramérica completaron el Inventario de Pensamientos Intrusos Desagradables para evaluar las consecuencias desadaptativas de experimentar IM muy molestas con contenidos de TOC, TDC, AE y TAs. RESULTADOS: Se obtuvieron efectos principales tanto para el país como para las consecuencias asociadas con los cuatro contenidos de IM, así como efectos de interacción entre las consecuencias de cada modalidad de IM y la localización de la muestra. CONCLUSIONES: Los modelos cognitivo-conductuales sobre el TOC, el TDC, la AE y los TAs deben complementarse con variables socioculturales que aumenten la comprensión del papel de esas variables en la fenomenología de las IM y sus consecuencias asociadas.

Group versus individual cognitive treatment for Obsessive-Compulsive Disorder: changes in non-OCD symptoms and cognitions at post-treatment and one-year follow-up.

Current cognitive approaches postulate that obsessions and compulsions are caused and/or maintained by misinterpretations about their meaning. This assumption has led to the development of cognitive therapeutic (CT) procedures designed to challenge the dysfunctional appraisals and beliefs patients have about their obsessions. Nonetheless, few studies have compared the efficacy of individual and group CT in changing the dysfunctional cognitions that hypothetically underlie Obsessive-Compulsive Disorder (OCD). In this study, 44 OCD patients were assigned to individual (n=18) or group (n=24) CT. Sixteen completed the individual CT, and 22 completed the group CT. The effects of the two CT conditions on depression and worry tendencies were comparable. Individual treatment was more effective than group treatment in decreasing scores on dysfunctional beliefs (responsibility, overestimation of threat, and intolerance to uncertainty) and the use of suppression as a thought control strategy. The post-treatment changes were maintained one year later. The correlations between symptom improvement (OCD severity change) and belief changes were moderate: in the individual treatment the greatest associations were with beliefs about thoughts (importance and control), whereas in the group treatment the greatest associations were with beliefs related to anxiety in general (threat overestimation and intolerance to uncertainty).

Videoconferencing Psychotherapy During the Pandemic: Exceptional Times With Enduring Effects?

With the advent of COVID-19, a sudden, unexpected, and forced shift has been produced in the field of psychotherapy. Worldwide, many therapists closed their offices and started to deliver psychotherapy online through a screen. Although different media started to be incorporated, videoconferencing is undoubtedly the most common way in which therapists are doing therapy these days. This is catalyzing a rapid change in the practice of psychotherapy with probable lasting effects and deserves to be carefully reflected upon. Therefore, in this paper our aim is to outline the main challenges for a medium that may have arrived to stay. In that sense, we review the literature to describe the state-of-the-art regarding the main aspects of videoconferencing psychotherapy as well as to suggest possible avenues for future research and practice.

Group versus individual cognitive treatment for obsessive-compulsive disorder: Changes in severity at post-treatment and one-year follow-up.

BACKGROUND: Very few studies have compared the efficacy of individual and group cognitive behaviour therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) by taking into consideration the change in OCD severity in both the short and long term. AIMS: To conduct an open trial of individual versus group CBT for OCD, comparing the clinical and statistically significant changes in severity both at post-treatment and one year later. METHOD: Forty-two OCD subjects were assigned to individual (n = 18) or group CBT (n = 24, in four groups). Sixteen and 22 subjects completed the treatment in the individual and group conditions, respectively. The Yale-Brown Obsessive Compulsive Scale was recorded at pre-treatment, post-treatment and at the one-year follow-up. RESULTS: At the end of treatment, the clinically significant change was comparable for the two treatment conditions and remained stable at the one-year follow-up. Of the 16 participants who completed the individual CBT treatment, 68.75% were classified as recovered at post-treatment, compared to 40.9% of those receiving group CBT. At follow-up the rate of recovery decreased to 62.5% in individual CBT and to 31.8% in group CBT. CONCLUSIONS: Group CBT is effective in decreasing OCD severity. The post-treatment changes were maintained one year later. Nevertheless, these changes were higher in the individual delivery of CBT.

The cross-cultural and transdiagnostic nature of unwanted mental intrusions.

BACKGROUND/OBJECTIVE: Unwanted mental intrusions (UMIs), typically discussed in relation to Obsessive-Compulsive Disorder (OCD), are highly prevalent, regardless of the specific nationality, religion, and/or cultural context. Studies have also shown that UMIs related to Body Dysmorphic Disorder (BDD), Illness anxiety/Hypochondriasis (IA-H), and Eating Disorders (EDs) are commonly experienced. However, the influence of culture on these UMIs and their transdiagnostic nature has not been investigated. METHOD: Participants were 1,473 non-clinical individuals from seven countries in Europe, the Middle-East, and South America. All the subjects completed the Questionnaire of Unpleasant Intrusive Thoughts, which assesses the occurrence and discomfort of four UMI contents related to OCD, BDD, IA-H, and EDs, and symptom questionnaires on the four disorders. RESULTS: Overall, 64% of the total sample reported having experienced the four UMIs. The EDs intrusions were the most frequently experienced, whereas hypochondriacal intrusions were the least frequent but the most disturbing. All the UMIs were significantly related to each other in frequency and disturbance, and all of them were associated with clinical measures of OCD, BDD, IA-H, and EDs. CONCLUSIONS: UMIs are a common phenomenon across different cultural contexts and operate transdiagnostically across clinically different disorders.

INTRODUCCIÓN/OBJETIVO: Las intrusiones mentales no deseadas (IM), clásicamente estudiadas en relación con el trastorno obsesivo-compulsivo (TOC), tienen una prevalencia elevada independientemente de la nacionalidad, religión, y/o el contexto cultural. Las investigaciones muestran que también es habitual experimentar IM sobre contenidos relacionados con el trastorno dismórfico corporal (TDC), la ansiedad por la enfermedad/hipocondría (AE-H) y los trastornos alimentarios (TCA). Sin embargo, la influencia de la cultura sobre estas IM y su naturaleza transdiagnóstica no se han investigado. MÉTODO: Participaron 1.473 personas de siete países de Europa, Oriente Medio y Suramérica. Todas completaron el Cuestionario de Pensamientos Intrusos Desagradables, que evalúa la ocurrencia y malestar asociados a cuatro contenidos de IM relacionados con TOC, TDC, AE-H y TCA, y cuestionarios sobre síntomas de los cuatro trastornos. RESULTADOS: El 64% de la muestra total había experimentado las cuatro modalidades de IM. Las IM-TCA fueron las más frecuentes y las hipocondríacas las menos, pero las más molestas. Todas las IM mantuvieron relaciones entre sí, tanto en frecuencia como en molestia, y todas se asociaron con las medidas clínicas de TOC, TDC, AE-H y TCA. CONCLUSIONES: Las IM son una experiencia habitual en diferentes contextos culturales y operan de modo transdiagnóstico en trastornos clínicamente distintos.

Integration in psychotherapy: Reasons and challenges.

Although integration has been formally influencing the field of psychotherapy since the 1930s, its impact gained significant momentum during the 1980s. Practical, theoretical, and scientific reasons help to explain the growing influence of integration in psychotherapy. The field of psychotherapy is characterized by many challenges which integration may change into meaningful opportunities. Nonetheless, many obstacles remain when seeking to advance integration. To appreciate the strength of integration in psychotherapy we describe an integrative, comprehensive approach to service delivery, research, and training. We then discuss the role of integration in the future of psychotherapy. (PsycINFO Database Record

[Cognitive group therapy]. / Terapia cognitiva de grupo.

This paper presents a brief history of group psychotherapy and it also makes a difference between two main kinds of cognitive group therapy: one linked to behavioral approaches and another one more related to postmodern, constructivist and narrative theories. Several domains where these approaches are used are exposed and the differences between one kind of cognitive group therapy and the other are put forward. While the behavioral like intends to fix errors or eliminate what does not work properly, the constructivist like tries to reconstruct a history which can be functional to subjective experience. At last, AIGLE depicts its integrative approach.

Presentación de una guía para la observación y clasificación de la conducta verbal de los Terapeutas / Presentation of an observation and classification guide of therapists' verbal behavior

El artículo presenta una guía de observación y clasificación de la conducta verbal de los terapeutas, la Guía de Observación de Terapeutas Aiglé (GOTA-v). Se revisan los estudios sobre la variable del terapeuta, especialmente el Estilo Personal y sus procedimientos de evaluación. Este nuevo instrumento fue aplicado a la transcripción de 44 sesiones de 12 terapeutas de Argentina con diferente orientación teórico-técnica y distinto grado de experiencia (bajo, medio y alto). Se delimitaron los textos de las sesiones en unidades de análisis y se clasificaron esas unidades con categorías pertenecientes a tres clases de actos de habla: Preguntas, afirmaciones e indicaciones. Se calculó el índice de acuerdo inter jueces de Kappa para cada clase. Se discuten los alcances y limitaciones del instrumento y sus posibilidades para la investigación en psicoterapia.

The article presents an observation and classification guide of therapists' verbal behavior, the Aiglé Therapists Observation Guide (ATOG-v). Studies on the therapist variables together with the assessment procedures are revisited. This new instrument was applied to the transcription of 44 sessions of 12 therapists in Argentina with different theoretical-technical orientation and different levels of experience (low, moderate and high). The session texts were delimited into analysis units and these units were classified with categories pertaining three types of speech acts: questions, statements and indications. The Kappa inter-judges index was applied for each class. The scope and limitations of the instrument and its possibilities for psychotherapy research are presented.

Psicoterapia cognitiva individual del TOC / Individual cognitive psychotherapy of OCD

A case study is presented in which cognitive therapy is applied to a case of obsessive-compulsive disorder, with contamination and verification rituals. The treatment emphasizes the importance of intervening on the specific metacognitive biases that patients have on their intrusive thoughts. The center of the intervention is not in the obsessions, but in the biased assessments. The post treatment evaluation showed a moderate improvement, a reduction of the biases, and a notable improvement of the functionality of the patient.

Se presenta un estudio de caso en el que se aplica psicoterapia cognitiva en un paciente con trastorno obsesivo compulsivo con intrusiones de contaminación y duda con rituales de lavado y verificación. El tratamiento se basa en el modelo cognitivo del TOC, que propone que los sesgos a través de los cuales se valoran las ideas intrusivas son el principal factor de mantenimiento del trastorno. Las intervenciones que de él se derivan incluyeron psicoeducación y técnicas cognitivas para flexibilizar esos sesgos. La evaluación de resultados post tratamiento mostró una mejoría moderada de los síntomas, una marcada flexibilización de los sesgos y una notable mejoría en la funcionalidad del paciente.

Measuring coping style and resistance among Spanish and Argentine samples: development of the Systematic Treatment Selection Self-Report in Spanish.

This article reports the reliability and validity of the Coping Style and Resistance subscales of the Systematic Treatment Selection Self-Report (STS-SR) scale after its translation to Spanish. The English versions of the STS system identify eight empirically derived patient variables that have been found to moderate the effects of various classes of mental health treatment procedures. Research on these dimensions as treatment indicators, as assessed both by clinicians and through patient self-reports, indicates that they increase the efficiency and effectiveness of treatment among English-speaking samples. This article reports a study of the convergent and discriminant validity of two of the subscales, Coping Style and Trait Resistance. The subscales were translated English into Spanish and administered to large Spanish and Argentine subject pools, along with established measures of the same and related constructs. Results revealed that both scales possessed good internal consistency and adequate discriminant validity. The implications of these findings are discussed.

Evaluación del estilo personal del terapeuta: presentación de una versión abreviada del cuestionario EPT-C / Assessment of personal style of the therapist: presentation of a brief versión of the PST-questionnaire

El Estilo Personal del Terapeuta (EPT) se conceptualiza como un constructo multidimensional que está presente en todo proceso terapéutico. El objetivo principal de este trabajo es presentar una versión abreviada del cuestionario EPT-C y proporcionar nuevas pruebas sobre la validez de este instrumento como herramienta para la evaluación del constructo. Se administró el EPT-C a una muestra de 461 psicoterapeutas argentinos. Se analizó la validez de constructo del cuestionario mediante Análisis Factorial Confirmatorio, se estudió la relación entre la versión breve y la original, y se evaluó la capacidad del instrumento para discriminar a los diferentes grupos de terapeutas en variables de relevancia para el proceso y los resultados de la psicoterapia. Los resultados indicaron un buen ajuste entre el modelo de medida pentafactorial del EPT-C y las dimensiones del constructo teórico. El cuestionario EPT-C aporta una medida sensible para detectar diferencias entre grupos de terapeutas a partir de varias características de los mismos.

The PST is conceptualized as a multidimensional construct which is present throughout the therapeutic pro-cess. The aim of this work is to present a brief version of the PST-Questionnaire and to give new evidence about the validity of the instrument to evaluate it. The PST-Q was administered to a sample of 461 argentine therapists. A confirmatory factor analysis was applied, and it was studied the relationship between the brief and original version. It was assessed its capacity to discriminate the differences between groups of therapists. The results indicated a good fit between the model of pentafactorial measure PST-Q and the dimensions of the theoretical construct. The PST-Q gives a measure to detect differences between groups of therapists.

Estilo pessoal do terapeuta:dados preliminares da versão brasileira do EPT-Q / Personal style of therapist: preliminary data from brazilian version of PST-Q

O Estilo Pessoal do Terapeuta pode ser entendido como um dos componentes do processo terapêutico,referindo-se a um conjunto de funções que se mostram de maneira integrada e expressam disposições, riscose atitudes que todo terapeuta evidencia em seu exercício profissional. Este estudo apresenta dados da versãobrasileira da Escala do Estilo Pessoal do Terapeuta (EPT-C) de Fernández-Alvarez e Garcia. Os procedimentosde adaptação seguiram os passos de tradução do instrumento do espanhol para o português, versãoavaliada por juízes, estudo piloto e versão final. A fidedignidade obtida nas classes Atenção, Comprometimentoe Operativa foram 0, 70, 0,71 e 0, 79, respectivamente. São apresentados dados descritivos referentesa 225 terapeutas brasileiros, comparando-se terapeutas menos e mais experientes, assim como desempenhosnas funções entre terapeutas cognitivos, psicanalíticos e integrativos. Conclui-se que a Escala pode ser umelemento importante no treinamento de terapeutas e apresenta características psicométricas satisfatórias naversão brasileira.

Therapist personal style might be understood as one of the components of the therapeutic process, referringto a group of functions which present themselves in an integrated way and express the dispositions, risks andattitudes that all therapists evidence at their practice. This study presents preliminary data from Brazilianversion of Fernández-Álvarez and Garcia’s Therapist’s Personal Style Questionnaire (PST-Q), designed tounderstand each therapist’s own style. The adaptation procedures followed translation steps: the versionfrom Spanish to Portuguese was evaluated by judges, there was a pilot study and finally the final version waswriten. The reliability obtained in the categories Attention, Involvement and Operative were 0.70, 0.71 e0.79, respectively. Descriptive data are presented, regarding 225 Brazilian therapists, comparing the mostand the least experienced, and differences between cognitive, psychoanalytical and integrative therapistswhen performing their functions. The conclusion is that the Scale may be an important element in therapisttraining and presents satisfactory psychometric characteristics in the Brazilian version.

Dependencia afectiva patológica / Pathological affective dependence

Se presenta el concepto de Dependencia Afectiva Psicológica (DAP). Este hace referencia a una forma estable de relación entre dos o más personas que provoca acciones de consecuencias dañinas i perjudiciales para sus integrantes. La DAP expresa un concepto relacional, con el cual se postula que la inadecuada composición del par dependencia/independencia, particularmente generada en la fase del reconocimiento personal, es la base de una disfuncionalidad que conspira contra el logro de la autonomía, actuando como factor condicionante de cualquier Trastorno de Personalidad. Se establecen las diferencias entre la DAP y el trastorno de personalidad por dependencia. Se analiza el principal factor desencadenante: la DAP se presenta cuando las personas optan por vivir una situación afectiva de caracter negativa antes que enfrentarse a la ausencia de afecto...

Presentación de un instrumento para la detección y valoración de las preocupaciones hiopocondríacas en la población general: El inventario de preocupaciones hipocondríacas Aiglé (IPHA) / Development of an instrument for the detection and valoration of hypochondriacal worries in general population: The inventory of hypochondriacal concerns-Aigle (IPHA)

La consideracion de la hipocondría en terminos dimensionales permite conceptuarla como el extremo patológico de las preocupaciones y los miedos por la salud y enfermedad normales. Además, sirve para comprender y predecir bajo que circunstancias personales, situacionales y de historia de vida, se produce el incremento mas o menos transitorio de tales preocupaciones, o por el contrario, su atenuación. Para poder ecaminar la existencia de esa supuesta dimensión, resulta imprescindible contar con instrumentos de evaluación válidos y fiables. Este trabajo presenta la elaboración y primeros resultados de un instrumento psicométrico para evaluar las preocupaciones y miedos hipocondríacos en la población general normal: El inventario de preocupaciones hipocondríacas de Aigle (IPHA)

Claves para la unificación de la psicoterapia. Más allá de la integración / Keys for the unification of psychotherapy. Beyond integration

En las últimas tres décadas la psicoterapia se ha expandido intentando dar respuesta a las demandas crecientes de asistencia producto del empeoramiento de las condiciones de vida, siendo muchas y variadas las opciones con que contamos. Este trabajo desarrollo los alcances y limitaciones que se presentan en las propuestas del movimeinto integrativo y fundamenta las bases tendientes a la unificación de la psicoterapia basándose en la demanda asistencial, los intereses de la investigación y los problemas críticos de la clínica. La investigación enfocada sobre el paciente es el mayor esfuerzo alcanzado hasta ahora para superar la brecha existente entre los estudios de eficacia y efectividad. Los modelos que surgen de esta orientación no están centrados en promover un enfoque teórico ni algún menú de técnicas en particualr, sino en identificar principios que ayuden a encontrar las combinaciones entre pacientes y terapeutas que permitan predecir mejor los resultados terapéuticos. En este artículo se describe el modelo de psicoterapia que se aplica en Aiglé que comparte los principios generales de los modelos que siguen una metodología que procura mejorar los resultados del tratamiento por medio del monitoreo de las sesiones y de proveer la información correspondiente a los terapeutas para guiar los pasos sucesivos de la terapia

Integración en psicoterapia / Integration in psychotherapy

El presente trabajo describe la relación dialéctica entre la tendencia a la integración y a la ruptura que ha existido, a través del tiempo, en la constitución del campo de las psicoterapias. Se describen las razones teóricas, clínicas y sociales que fundamentan la disposición a la integración de diferentes orientaciones de psicoterapia y su contrapartida en las sucessivas rupturas teóricas