RESUMO
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.
Assuntos
Educação a Distância/métodos , Educação de Pós-Graduação/métodos , Relações Interprofissionais , Psicoterapia/educação , Adulto , Argentina , Educação a Distância/normas , Feminino , Guatemala , Humanos , Masculino , Desenvolvimento de ProgramasRESUMO
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.
Assuntos
Organização e Administração/normas , Psicoterapia/normas , Humanos , Psicoterapia/educaçãoRESUMO
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.
Assuntos
Humanos , Masculino , Adolescente , Feminino , Adulto Jovem , Comportamento Verbal , Psicoterapia/métodos , Relações Médico-Paciente , Atitude do Pessoal de Saúde , Guias como Assunto , Inquéritos e Questionários , ObservaçãoRESUMO
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.
Assuntos
Fundações/organização & administração , Pesquisa sobre Serviços de Saúde/organização & administração , Psicoterapia/normas , Argentina , Humanos , Psicoterapia/educaçãoRESUMO
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.
RESUMO
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).
Assuntos
Cognição/fisiologia , Terapia Cognitivo-Comportamental/métodos , Transtorno Obsessivo-Compulsivo/psicologia , Transtorno Obsessivo-Compulsivo/terapia , Adolescente , Adulto , Idoso , Análise de Variância , Argentina/epidemiologia , Cultura , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica , Espanha/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
El presente estudio cualitativo analiza, partiendo de la experiencia subjetiva de los pacientes, los resultados de un programa de terapia cognitiva para el trastorno obsesivo compulsivo (TOC). Se comparan estas narraciones con los resultados obtenidos en las pruebas cuantitativas. Se discuten las diferencias entre las metodologías cuantitativas y cualitativas, y sus ventajas y limitaciones. Se distinguen los efectos del tratamiento en la conducta y la experiencia, entendiendo esta última como la síntesis vivencial del conjunto de estados mentales -representaciones interiorizadas- que produce una persona y que se expresa a través de procesos metacognitivos. La mayoría de los pacientes organizan su experiencia subjetiva de cambio en términos de mejoría, no de recuperación. Este resultado es compatible con la evolución de las puntuaciones en las medidas de la Y-BOCS e INPIOs sobre el trastorno. Se concluye que los relatos de todos los pacientes muestran una evaluación favorable de sus procesos terapéuticos, independientemente de las diferencias en los resultados de las evaluaciones cuantitativas. Al describir los cambios son muchas más las ilustraciones que realizan sobre aspectos sintomáticos que sobre la experiencia.
This qualitative study explores the impact of a cognitive therapy program on the subjective experience of patients suffering from obsessivecompulsive disorder (OCD). The accounts given by patients were compared with the results obtained from quantitative measures of symptom improvement. A distinction is made between the impact of treatment on patients behavior and on their lived experience. An individuals experience is seen as a synthesis of his or her mental states (internal representations) expressed through metacognitive processes. Most of the patients organized their subjective experience of change in terms of improvement, not recovery. This was consistent with reduced scores on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Obsessive Intrusive Thoughts Inventory (INPIOs). We conclude that all the patients stories showed a positive evaluation of their therapeutic process, irrespective of quantitative assessment results. Patients tended to describe changes more in terms of symptoms rather than in terms of experience. The advantages and limitations of using qualitative and quantitative methodologies in this context are also discussed.
Assuntos
Humanos , Transtorno Obsessivo-CompulsivoRESUMO
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.
Assuntos
Humanos , Inquéritos e Questionários , Psicoterapia/instrumentação , Variações Dependentes do Observador , Análise de Variância , Argentina , Pesquisa , Psicometria/instrumentação , Reprodutibilidade dos TestesRESUMO
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 Garcias Therapists Personal Style Questionnaire (PST-Q), designed tounderstand each therapists 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.
Assuntos
Humanos , Psicoterapia , Inquéritos e QuestionáriosRESUMO
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)
Assuntos
Saúde , Hipocondríase , Doença , MedoRESUMO
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)
Assuntos
Hipocondríase , Saúde , Medo , DoençaRESUMO
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
Assuntos
Modelos Teóricos , PsicoterapiaRESUMO
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
Assuntos
Psicoterapia , Modelos TeóricosRESUMO
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.
Assuntos
Adaptação Psicológica , Inventário de Personalidade , Adulto , Argentina/etnologia , Feminino , Humanos , Idioma , Masculino , Planejamento de Assistência ao Paciente , Psicometria , Reprodutibilidade dos Testes , Espanha/etnologiaRESUMO
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.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtornos Mentais/terapia , Psicoterapia de Grupo/métodos , HumanosRESUMO
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.
RESUMO
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.