RESUMEN

OBJECTIVE: To identify predictive factors for the length of physiotherapy sessions for adult intensive care unit (ICU) patients. DESIGN: Longitudinal panel study. SETTING: ICU of a secondary-care public teaching hospital, the University Hospital at the University of Sao Paulo, Brazil. PARTICIPANTS: Medical and surgical patients who received physiotherapy (N=181) assessed in 339 physiotherapy sessions. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The study investigator followed physiotherapists during their work shift and timed the physiotherapy session's length with a stopwatch. The association between session length and patient, physiotherapist, and service-related factors was evaluated by a mixed model. RESULTS: Assessed in this study were 339 physiotherapy sessions during 79 periods of observation that involved 181 patients and 19 physiotherapists. Median session length was 29 (interquartile range: 22.6-38.9) minutes; median number of patients assisted per physiotherapist per 6-hour shift was 5 (4-5). Physiotherapist's median age was 35 (26-39) years old, and median ICU experience was 13.0 (0.4-16.0) years. Patients were mostly older adults who were post surgery and had been at the ICU for 5 (2-9) days. Factors associated with physiotherapy session length (min) were the following: performing both motor- and respiratory-related physiotherapy procedures during the session (ß=6.5; 95% confidence interval [CI], 3.8-9.2), altered chest x-ray (ß=2.8; 95% CI, 0.3-5.3), ICU mobility scale (IMS) (ß=1.2; 95% CI, 0.4-2.0), contraindication to any level of out-of-bed mobilization (ß=-6.9; 95% CI, -10.5 to -3.3), afternoon shift (ß=-4.0; 95% CI, -6.7 to -1.4), and Barthel index (ß=-0.2; 95% CI, -0.3 to -0.1). CONCLUSIONS: The factors associated with longer session lengths were performing both motor- and respiratory-related physiotherapy procedures during the session, altered chest x-ray, and the IMS. Contraindication to any level of out-of-bed mobilization and sessions performed during the afternoon shift (vs the morning shift) were associated with shorter session lengths.

Asunto(s)

RESUMEN

OBJECTIVES: The therapeutic alliance (TA) has been shown to be a predictor of psychotherapy treatment success. In the case of psychotherapy with children, there is a dearth of information on TA's role. The aims of the paper are: (1) To estimate the therapist effects on children TA; (2) to investigate if therapists' TA predicts children's TA; (3) to analyze if children's age and sex predict children's TA; (4) to evaluate if the therapist's characteristics predict children's TA. METHODS: The sample consisted of 77 children undergoing psychotherapy in Argentina, and the therapists (N = 29) providing services to those children. The assessment tools utilized for the study included the Therapy Alliance Scale for Children and the Personal Style of the Therapist Questionnaire (PST-Q). RESULTS: Findings indicated that 2% of the children's TA was explained by the therapists (ICC = 0.02), while 17% of the therapists' TA was explained by the therapists (ICC = 0.17). Therapists' TA predicted children's TA. Children's age and sex did not have an effect on their own TA. Moreover, therapists with more experience achieved higher scores of children's TA. Finally, the Operative dimension of the PST had a negative effect on children's TA (i.e., therapists who prefer more spontaneous interventions over structured ones may experience higher levels of therapeutic alliance with child patients). CONCLUSION: We found a positive effect of the therapist's TA on children's TA, especially in the preference for using more spontaneous intervention techniques. We discuss the implications of the findings on the training of psychotherapists who provide services to children.

Asunto(s)

RESUMEN

BACKGROUND: Musculoskeletal pain (MSP) is the largest contributor to chronic pain and frequently occurs alongside other medical comorbidities. OBJECTIVE: Explore the relationships between the presence of pain-related comorbidities, pain intensity, and pain-related psychological distress in patients with MSP. METHODS: A longitudinal assessment of individuals 18-90 years old in the Midwestern United States beginning a new episode of physical therapy for MSP. Electronic medical records were assessed the full year prior for care-seeking of diagnoses for pain-related comorbidities (anxiety, metabolic disorder, chronic pain, depression, nicotine dependence, post-traumatic stress disorder, sleep apnea, and sleep insomnia). Pain intensity and pain-related psychological distress (Optimal Screening for Prediction of Referral and Outcome - Yellow Flags tool) were captured during the physical therapy evaluation. Generalized linear models were used to assess the association between pain intensity, psychological distress, and pain-related co-morbidities. Models were adjusted for variables shown in the literature to influence pain. RESULTS: 532 participants were included in the cohort (56.4% female; median age of 59 years, Interquartile Range [IQR]:47, 69). Comorbid depression (beta coefficient (ß) = 0.7; 95%CI: 0.2, 1.2), spine versus lower extremity pain ((ß = 0.6; 95%CI: 0.1, 1.1), and prior surgery (ß = 0.8, 95%CI: 0.3, 1.4) were associated with higher pain intensity scores. No pain-related comorbidities were associated with pain-related psychological distress (yellow flag count or number of domains). Female sex was associated with less pain-related psychological distress (ß = -0.2, 95%CI: -0.3, -0.02). CONCLUSIONS: Depression was associated with greater pain intensity. No comorbidities were able to account for the extent of pain-related psychological distress.

Asunto(s)

RESUMEN

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.

Asunto(s)

RESUMEN

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.

Asunto(s)

RESUMEN

Abstract Introduction Variations in clinical practice regarding the management of benign paroxysmal positional vertigo (BPPV) among clinicians have been noted in previous studies. Such variations might be related to the different adherence to clinical practice guidelines. Objective To evaluate clinicians' adherence to BPPV guidelines and investigate the variations in the adherence between different specialties and qualifications. Methods This is a cross-sectional study with a vignettes-based survey conducted between June and August, 2020. We included clinicians engaged in managing BPPV that had at least one year of clinical experience. We excluded students, and clinicians who were not involved in the management of individuals with BPPV. Participants were asked to make their management choices based on four hypothetical patient vignettes. The sample ranged from 77 participants for the first vignette to 45 participants for the last vignette. Results We included 77 clinicians in the study, with the majority being Otolaryngologists (31.2%). The respondents' mean adherence to the guideline was of 63.3%. Result showed that Otolaryngologists' adherence was higher than that of clinicians from different specialties (p = 0.006, d = 0.72). Furthermore, clinicians with a postgraduate degree were more likely to adhere than those with a bachelor's degree only (p = 0.014, d = 0.58) and participants who were aware of the guideline were more likely to adhere to it (p < 0.001, d = 1.05). Lastly, regression analysis exhibited that adherence was affected by postgraduate degree and guideline awareness. Conclusion Otolaryngologists were more likely to adhere to the guideline than other specialties. Among all specialties, higher adherence was associated with guideline awareness and postgraduate degrees.

RESUMEN

BACKGROUND: A good state of oral health allows people to communicate and eat. This topic is relevant in older people given its close relationship with their general health. At present, health challenges are directed at detecting and preventing oral disorders and are seen to exclusively by dentists, because the existing instruments can only be applied by them. However, speech-language therapists undergo similar training, which would allow them to collaborate in these processes. In this context, the Oral Health Assessment Tool (OHAT) is a detection instrument with good psychometric properties that is currently available for non-dental use. The objective of this study is the translation into Chilean Spanish of the OHAT and a structural validation of that version for application by these professionals. MATERIALS AND METHODS: A mixed qualitative-quantitative study was carried out. The OHAT instrument was adapted to Chilean Spanish and subsequently subject to structural validity and evaluation of internal consistency reliability, as well as a valuation of its reproducibility in 286 older people (166 female, 120 male) from different health contexts. RESULTS: The cultural adaptation of the instrument proved to be semantically consistent with the original instrument. Its application was considered to be speedy and simple in the pre-test. The confirmatory factor analysis evidenced the unidimensionality of the OHAT. In addition, the instrument shows good internal consistency and test-retest reliability. CONCLUSIONS: The OHAT instrument was considered to possess adequate structural validity and test-retest reliability properties. Its usefulness in the context of oral health disorders of this population in Chile is discussed.

Asunto(s)

RESUMEN

Introduction Variations in clinical practice regarding the management of benign paroxysmal positional vertigo (BPPV) among clinicians have been noted in previous studies. Such variations might be related to the different adherence to clinical practice guidelines. Objective To evaluate clinicians' adherence to BPPV guidelines and investigate the variations in the adherence between different specialties and qualifications. Methods This is a cross-sectional study with a vignettes-based survey conducted between June and August, 2020. We included clinicians engaged in managing BPPV that had at least one year of clinical experience. We excluded students, and clinicians who were not involved in the management of individuals with BPPV. Participants were asked to make their management choices based on four hypothetical patient vignettes. The sample ranged from 77 participants for the first vignette to 45 participants for the last vignette. Results We included 77 clinicians in the study, with the majority being Otolaryngologists (31.2%). The respondents' mean adherence to the guideline was of 63.3%. Result showed that Otolaryngologists' adherence was higher than that of clinicians from different specialties ( p = 0.006, d = 0.72). Furthermore, clinicians with a postgraduate degree were more likely to adhere than those with a bachelor's degree only ( p = 0.014, d = 0.58) and participants who were aware of the guideline were more likely to adhere to it ( p < 0.001, d = 1.05). Lastly, regression analysis exhibited that adherence was affected by postgraduate degree and guideline awareness. Conclusion Otolaryngologists were more likely to adhere to the guideline than other specialties. Among all specialties, higher adherence was associated with guideline awareness and postgraduate degrees.

RESUMEN

OBJECTIVE: This study explores in cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD) to what degree therapists' perceptions of their patients as interpersonally challenging (IC) is explained by the therapist or patient effects, if baseline patients' characteristics predict IC, and if IC is related to outcome. METHOD: Eighty patients diagnosed with GAD and treated by 20 therapists with 16 sessions of CBT were randomized to two different implementation conditions. Patients completed baseline measures of depression, anxiety, interpersonal problems, and interpersonal strengths. The therapists completed a single-item assessing IC session-by-session. As an outcome, patients completed a worry measure at baseline, session 5, session 10, and posttreatment. RESULTS: Multilevel models showed meaningful therapist effects, explaining 18% of IC variance. Interpersonal strengths were the only baseline predictor significantly and negatively associated with IC during treatment. Structural equation models showed significant negative IC effects on subsequent patient worry during therapy. CONCLUSIONS: IC might represent a risk factor for psychotherapy outcome. Patient interpersonal strengths at baseline may buffer therapists perceiving their patients as ICs. The therapist effects on IC suggest that CBT clinicians treating GAD might benefit from identifying cases that are interpersonally challenging for them and reflecting about what might trigger that perception.

Asunto(s)

RESUMEN

In this article we will present a phenomenological approach to empathy and its relationship with emotions in the context of psychotherapy, highlighting the importance of empathy as a key element of the therapist-client relationship and therapeutic process, regardless of the therapist's approach. We will use a consensus definition of empathy taken from phenomenologically oriented philosophy to analyze therapist's empathy, as well as client's self-empathy and client's empathic communication with others. We will discuss emotions as they usually manifest in the context of psychotherapy, specifically describing how certain emotions can disturb empathic communication in close personal relationships and how it is possible to reestablish empathic communication in psychotherapy. This article it is not only based on evidence from scientific literature but also incorporates the authors' practical knowledge of psychotherapy.

RESUMEN

Objetivo: avaliar o nível de atividade física dos fisioterapeutas e identificar o perfil socioeconômico desses profissionais de um hospital público de grande porte em Goiânia. Métodos: Trata-se de um estudo observacional, transversal e quantitativo realizado de abril a agosto de 2020. Foram incluídos fisioterapeutas de ambos os sexos, contratados há no mínimo seis meses, e que assinaram o termo de consentimento livre e esclarecido. Excluídos da pesquisa aqueles em férias ou licença médica no período da coleta de dados. Para avaliar o nível de atividade física utilizou-se o Questionário Internacional de Atividade Física (IPAQ), e um questionário para conhecer o perfil socioeconômico desses profissionais. As variáveis contínuas foram apresentadas como média e desvio padrão, enquanto as categóricas, em frequência absoluta e relativa. Resultados: Grande parte dos indivíduos é do sexo feminino (73,5%) com maior prevalência de inativos (76%), sendo que (49,9%) cumprem carga horária maior que 30 horas semanais. Do total da amostra (61,8%) tem pelo menos especialização na sua formação profissional. Conclusão: Os fisioterapeutas do serviço público apresentam o nível de atividade física reduzido, com maior proporção classificados como inativos, segundo a OMS.

Purpose: evaluate the level of physical activity of physical therapists and identify the socioeconomic profile of these professionals in a large public hospital in Goiânia. Methods: This is an observational, cross-sectional and quantitative study carried out from April to August 2020. Physical therapists of both sexes, hired for at least six months, and who signed a free and informed consent form, were included. The research excluded those on vacation or sick leave during the data collection period. In order to assess the level of physical activity, the International Physical Activity Questionnaire (IPAQ) was used, as well as a questionnaire to learn about the socioeconomic profile of these professionals. Continuous variables were presented as mean and standard deviation, while categorical variables were in absolute and relative frequency. Results: Most of the individuals are female (73.5%) with a higher prevalence of inactive people (76%), and (49.9%) working more than 30 hours per week. From the total sample, 61.8% were at least specialists in their areas. Conclusion: Public service physical therapists have a reduced level of physical activity, with a greater proportion being classified as inactive, according to WHO.

Asunto(s)

RESUMEN

Long-term care facilities for older adults (LTCFs) were directly affected by the COVID-19 pandemic. This study aimed to discuss the perceptions of occupational therapists about deaths and other losses in LTCFs during the pandemic. This qualitative study is anchored in social phenomenology, and conducted in-depth interviews with eight occupational therapists who worked in LTCFs. Thus, two themes were generated after the Thematic Analyses: "The proximity of death" and "Losses associated with living and dying in a LTCF." In the first theme, the interviewees addressed the feeling of imminent death in the daily life of the LTCF, and feelings related to their own death, that of their family members and other older adults. In the second, the professionals highlighted three groups of losses: social, functional, and psychological/cognitive. These results highlighted the challenges faced by occupational therapists and can contribute to improve behavior and care for institutionalized older adults during the pandemic.

RESUMEN

OBJECTIVE: The purpose of this study was to compare (1) the effects of the instrument-assisted perineal stretching technique with different application protocols in combination with perineal massage and (2) the effects of the isolated techniques on the extensibility and strength of the pelvic floor muscles (PFMs). METHODS: A randomized controlled clinical trial with parallel randomization, assessor blinding, and concealed allocation was conducted in the Campus Physical Education at the Federal University of Uberlândia in Brazil. Ninety-six pregnant women (18-40 years of age) were allocated into 4 groups: perineal massage (PnM) group (PnM protocol for 10 minutes); instrument-assisted perineal stretching with a long static protocol for 15 minutes [IStrLS group]); PnM + IStrLS group (both techniques applied in the 2 previous groups); and PnM + IStrSR group (the same techniques as used in the PnM + IStrLS group but with a short repeated protocol; 4 sets lasting 30 seconds each). Eight interventions were performed in all 4 groups twice weekly (beginning at the 34th gestational week). The primary outcome was PFM extensibility, assessed using vaginal dilator circumference, and the secondary outcome was PFM strength, assessed using vaginal manometry. RESULTS: For the PFM extensibility variable, a significant main effect of time (F2,88 = 87.951) and group (F3,88 = 7.193) was found. Tukey post hoc test results showed that the PnM + IStrSR group presented greater extensibility than the PnM and IStrLS groups. The PnM group showed increased PFM strength after 8 sessions compared with the other groups. CONCLUSIONS: Women who were pregnant and received the combination of perineal massage and instrument-assisted perineal stretching with short repeated application had a greater increase in PFM extensibility than perineal massage and instrument-assisted perineal stretching alone. IMPACT: The combination of perineal massage and instrument-assisted perineal stretching techniques with a short, repeated protocol led to better PFM extensibility results than the application of the techniques alone in women who were pregnant. LAY SUMMARY: Pregnant women can benefit from intervention using the combination of perineal massage and instrument-assisted perineal stretching techniques with a short, repeated protocol.

Asunto(s)

RESUMEN

Nowadays, fuzzy-logic systems are implemented to control machinery or processes that previously required human manipulation. The main objective of this research is to propose a controller based on fuzzy-logic that uses bio-signals for decision making. The study presents the implementation of a fuzzy-speed controller for a therapeutic machine called cycloergometer. It is used in patients who require rehabilitation therapy to improve their mobility in the lower body or to increase their relaxation or flexibility. Basic controllers have been developed where the speed is decided through a user interface, and the therapist must constantly increase or decrease the speed according to the condition of the patient. In this paper, the speed of the therapy equipment is adjusted using the heart rate of the patient. In this way, a bio-signal is used to determine whether a person is tired or relaxed. Therefore, a mechanism is obtained that is not subject to the visual criteria of the therapist. A detailed review of the literature illustrates that one of the main limitations of electroencephalography and electromyography recordings is the low signal-to-noise ratio and the fact that the signals captured at the electrodes are a mixture of sources that cannot be observed directly with noninvasive methods. Therefore, it was decided to work with electrocardiogram-based signals for better robustness of the proposed system. The controller output is a voltage signal in PWM, which is determined by the membership and error functions. The behavior of the implemented controller is validated by different experimental tests based on the increase and decrease of the simulated and real heart rate of a patient. Finally, the results obtained and the possible areas of opportunity for the proposed design are discussed.

Asunto(s)

RESUMEN

OBJECTIVE: : This study describes therapists' experience of moments of meeting with their patients in psychotherapy, and how these moments relate to the patient's change process. METHOD: 13 in-depth interviews conducted with therapists from different theoretical backgrounds were analyzed using Grounded Theory. RESULTS: Four categories were established: (1) Characteristics of moments of meeting, (2) Triggers of moments of meeting (3) Enabling conditions, and (4) Main effects of moments of meeting. A conceptual model was developed around an axial phenomenon that provides understanding on how moments of meeting contribute to the change process in psychotherapy, through the construction of shared relational knowing. DISCUSSION: : The value of moments of meeting for the therapeutic process is discussed and reflected upon, as well as their effect on changes regarding implicit relational knowing.

Asunto(s)

RESUMEN

El trabajo de fonoaudiólogos (as) en contextos educativos es esencial para estudiantes que presentan necesidades educativas especiales. Sin embargo, poco se sabe respecto a cómo influye la asignación del tiempo otorgado por la política educativa en sus prácticas fonoaudiológicas. El presente estudio analizó por primera vez en Chile la experiencia de fonoaudiólogos (as) con más de 20 años de ejercicio laboral respecto de la asignación del tiempo definido por la política pública para la práctica fonoaudiológica que se lleva a cabo en los entornos educativos. Se realizó un estudio cualitativo con enfoque construccionista-narrativo. Se realizaron cinco entrevistas semiestructuradas a fonoaudiólogos con más de veinte años de experiencia laboral en educación a través de un análisis de contenido de tipo deductivo. Los resultados muestran que la práctica fonoaudiológica presenta desafíos provenientes de aspectos administrativos, organizativos y prácticos que surgen de una política pública que no define de manera clara la asignación de tiempo y su distribución en las funciones propias del rol fonoaudiológico en educación. El aporte de esta investigación pionera en la temática,es que los fonoaudiólogos entrevistados sugieren cambios a la política implementada a partir de los ajustes que han realizado en sus prácticas profesionales tras 20 años de experiencia laboral. Es necesario continuar en la investigación sobre el ejercicio del rol fonoaudiológico en contextos educativos con el fin de mejorar la práctica profesional y contribuir a la política educativa implementada.

Speech therapists' work in educational contexts is essential for students presenting special educational needs. However, little is known about the influence of the amount of time granted by educational policy in speech therapists' professional practice.The present study did the first analysis in Chile of the experience of speech therapists with over 20 years of professional experience regarding the amount of time defined in public policy for speech therapists' practice carried out in educational environments. A qualitative study with a constructionist-narrative focus was done. Five semi-structured interviews were carried out with speech therapists who had over 20 years' professional educational experience via an inductive-type content analysis. Results showed that speech therapists' practice presents challenges arising from administrative, organizational and practical aspects emerging from a public policy which does not clearly define time assignment and its distribution in the functions pertaining to speechtherapists' educational role. The contribution of this pioneering research on the subject is that the speech therapists interviewed suggest changes to the policy implemented on the basis of the adjustments they have made in their professional practices after 20 years of work experience. It is necessary to continue research on the exercise of the role of speech therapists in educational contexts in order to improve professional practice and contribute to the educational policy implemented.

Asunto(s)

RESUMEN

La presente investigación presenta la relación entre el proceso formativo en entrenamiento de habilidades básicas de intervención y el estilo personal del terapeuta (EPT), en un grupo de 10 pasantes en el Centro de Atención Psicológica CAPS La Serena, Psicólogas/os egresadas/os en el 2018 de la carrera de Psicología de la Universidad Santo Tomás, sede La Serena. El diseño del estudio es preexperimental de tipo longitudinal, con aplicación pre o post, con el cuestionario del estilo personal del terapeuta o EPT-C (Fernández Álvarez, Garcia, LoBianco y Corbella, 2003), instrumento autoadministrado con 36 afirmaciones en una escala Likert del 1 al 7 según el grado de acuerdo, que permite un análisis multidimensional de las funciones del constructo EPT, instruccional, atencional, expresiva, operacional e involucración. Se describen los resultados de la aplicación EPT-C pre y post entrenamiento, en tanto, no se observan cambios significativos en la muestra.

This research introduces the relationship between the formative process in basic intervention skills training and the Personal Style of the Therapist (PST) in a group of 10 interns at the Centro de Atención Psicológica CAPS, La Serena. The interns are psychologists who graduated from the psychology career of the Universidad Santo Tomás in 2018, La Serena campus. This study has a pre-experimental and longitudinal design, with pre-test or post-test application. The Personal Style of the Therapist Questionnaire or PST-Q (Fernández Álvarez, Garcia, LoBianco and Corbella, 2003) was used as a self-administered instrument with 36 responses on a Likert-type scale from 1 to 7 according to the level of agreement, which allows multidimensional analysis of the functions of the PST construct: instructional, attentional, expressive, operational and involvement. The result describes the pre and post-training PST-Q application with no significant changes in the sample.

Asunto(s)

RESUMEN

En los últimos años, se ha formado un cuerpo creciente de investigación sobre el estilo personal del terapeuta, entendido como un modo propio y personal de ejercer en la clínica (Fernández-Álvarez & García, 1998). Su profundización ha permitido conocer cómo se asocia con el ámbito de trabajo, la línea teórica y la personalidad. No obstante, pocos son los estudios que han investigado este constructo en estudiantes. Por tanto, se pretende evaluar si existen modificaciones en el estilo y en la personalidad tras el entrenamiento clínico en la carrera de grado, y analizar las relaciones entre ambos aspectos. Se trabajó con 77 estudiantes del último año de psicología, que fueron evaluados antes y después de sus prácticas pre-profesionales clínicas con el Cuestionario de Estilo Personal del Terapeuta (Fernández-Álvarez et al., 2003) y el Big Five Inventory (John, 1990). Los resultados apuntan a un aumento de la cercanía emocional y una menor rigidez en el encuadre terapéutico, así como un incremento de la sociabilidad y de la estabilidad emocional luego de las prácticas. El modo en que se relacionan estos factores presenta variaciones respecto estudios con terapeutas en ejercicio, lo que da cuenta de que existen importantes diferencias entre ambos grupos

In recent years, a growing body of research has been conducted on the personal style of the therapist, understood as a personal way of practising in the clinic (Fernández-Álvarez & García, 1998). Its deepening has allowed us to know how it is associated with the field of work, the theoretical line and personality. However, few studies have investigated this construct in students. Therefore, the aim was to assess whether there are modifications in style and personality after undergraduate clinical training and to analyse the relationships between both aspects. We worked with 77 final-year psychology students assessed before and after their pre-professional clinical practice with the Therapist Personal Style Questionnaire (Fernández-Álvarez et al., 2003) and the Big Five Inventory (John, 1990). The results point to an increase in emotional closeness and less rigidity in the therapeutic setting and an increase in sociability and emotional stability after the internship. The relations among these factors show variations regarding studies with practising therapists, which shows that there are essential differences between the two groups

Asunto(s)

RESUMEN

Resumen Objetivo: explorar las reacciones de contratransferencia de los terapeutas en la fase inicial de la psicoterapia psicoanalítica (entre las sesiones 4 y 5) y verificar las posibles asociaciones entre estas y las características personales del paciente (sociodemográficas, psicológicas y psicopatológicas). Método: estudio naturalista, transversal, correlacional y observacional con enfoque descriptivo-analítico. La muestra consta de 180 pares de pacientes y terapeutas, de los cuales 180 eran pacientes adultos (32.82 ± 12.66 años) y 48 terapeutas (32.69 ± 10.01 años). Resultados: la contratransferencia se ve afectada por la edad del paciente, los aspectos psicológicos de su vida anterior (traumas y apego parental) y elementos de su personalidad (habilidades de empatía y mecanismos defensivos), pero no por los síntomas que presenta. Conclusiones: los hallazgos respaldan la literatura científica, que señala la relevancia de las experiencias infantiles y las características de personalidad del paciente para evocar patrones específicos de contratransferencia en el terapeuta. Conocer tales relaciones puede ayudar a los clínicos a identificar sus propias reacciones y usarlas terapéuticamente, según corresponda.

Resumo Objetivo: explorar as reações contratransferenciais de terapeutas na fase inicial de psicoterapia psicanalítica (entre a 4a e a 5a sessão) e verificar possíveis associações destas com as características pessoais do paciente (sociodemográficas, psicológicas e psicopatológicas). Método: estudo naturalístico, transversal, correlacional e observacional de abordagem descritivo-analítica. A amostra é composta por 180 duplas paciente-terapeuta, dos quais 180 eram pacientes adultos (32,82 ± 12,66 anos de idade) e 48 terapeutas (32,69 ± 10,01 anos de idade). Resultados: a contratransferência é afetada pela idade do paciente, aspectos psicológicos da sua vida pregressa (traumas e vinculação parental) e elementos de sua personalidade (habilidades empáticas e mecanismos defensivos), mas não pelos sintomas. Conclusões: os achados apoiam a literatura científica, a qual sinaliza a relevância das experiências infantis e de características da personalidade do paciente na evocação de padrões contratransferenciais específicos no terapeuta. Conhecer tais relações pode ajudar os clínicos a identificar suas próprias reações emocionais e utilizá-las terapeuticamente, quando for o caso.

Abstract Objective: to explore therapists' countertransference reactions in the initial phase of psychoanalytic psychotherapy (between sessions 4 and 5) and to verify possible associations between these and the patient's personal characteristics (sociodemographic, psychological, and psychopathological). Method: naturalistic, cross-sectional, correlational, and observational study with a descriptive-analytical approach. The sample consists of 180 patient-therapist dyads, of which 180 were adult patients (32.82 ± 12.66 years old) and 48 therapists (32.69 ± 10.01 years old). Results: countertransference is affected by the patient's age, psychological aspects of his or her previous life (traumas and parental attachment) and elements of personality (empathetic skills and defensive mechanisms), but not by the showed symptoms. Conclusions: the findings support the scientific literature, which points to the relevance of childhood experiences and personality characteristics of the patient to evoke specific countertransference patterns in the therapist. Understanding such relationships can help clinicians identify their own reactions and deliver the therapy, as appropriate.

RESUMEN

A violência psicológica por parceiro íntimo ocorre entre cônjuges ou namorados e frequentemente tem a mulher a vítima deste abuso. Visto que toda violência física foi precedida de uma violência psicológica, postula-se a importância deste tema como uma forma de prevenção e alerta para a sociedade. O Gestalt-terapeuta deve estar preparado ao se deparar com estes casos e saber quais posturas assumir em diferentes contextos. Para isso, o presente estudo apresenta um estudo teórico sobre violência psicológica por parceiro íntimo pautado em uma pesquisa nos principais periódicos da abordagem gestáltica no país. A discussão aborda cinco termos que mais apareceram nos trabalhos nacionais, são eles: Heterossuporte, Awareness, Redução Fenomenológica, Trabalho com Emoções e Autoestima. Nesta discussão, busca-se compreender os conceitos a luz da teoria gestáltica e sua aplicação no atendimento às mulheres vítimas de violência psicológica por parceiro íntimo.

Psychological intimate partner violence occurs between spouses or boyfriends and often has the woman the victim of this abuse. Since all physical violence was preceded by psychological violence, the importance of this theme is postulated as a form of prevention and alertness to society. The Gestalt-therapist should be prepared to come across these cases and know which positions to take in different contexts. For this, the present study presents a theoretical study on psychological violence by intimate partner based on a research in the main journals of the Gestalt approach in the country. The discussion addresses five terms that have appeared the most in the national works, they are: Environmental Support, Awareness, Phenomenological Reduction, Work with Emotions and Self-esteem. In this discussion, we seek to understand the concepts in light of gestalt theory and its application in the care of women victims of psychological violence by intimate partner.

La violencia psicológica de la pareja íntima ocurre entre cónyuges o novios y com frecuencia tiene a la mujer como víctima del abuso. Dado que toda violencia física se procede por violencia psicológica, la importância del tema se postula como una forma de prevención y atención a la sociedad. El terapeuta Gestalt debe prepararse para enfrentar estos casos y saber qué posiciones adoptar en diferentes contextos. El presente manuscrito presenta um estudio teórico sobre la violencia psicológica por pareja íntima basado en una investigación em las principales revistas del enfoque Gestalt em el país. La discusión aborda cinco conceptos que han aparecido más en las obras nacionales, que son: Apoyo ambiental, Conciencia, Reducción fenomenológica, Trabajocon emociones y Autoestima. E nesta discusión, buscamos comprenderlos conceptos a la luz de la teoría de la gestalt y sua plicación em el cuidado de las mujeres víctimas de violencia psicológica por parte de supareja.

Asunto(s)