The use of the "Once-Upon-A-Time…" Test in treatment outcome assessment

In an era in which the advent of managed health care is questioning the value of traditional psychological assessment, we discuss the role of the "Once-upon-a-time…" Test in treatment outcome assessment. The "Once upon a time..." Test (Fagulha, 1992, 1997) is a storytelling projective technique whose purpose is to describe the way children deal with the emotions of anxiety and pleasure. In psychodynamic theories, these emotions have an important adaptive function for psychological development (Freud, 1926/1978; Klein, 1932/1969). The “Once upon a time..." Test task is to complete seven stories which are presented as pictures in a cartoon format. Each story depicts common situations in the life of any child that evoke emotions of anxiety and of pleasure. Five cards refer to anxiety provoking situations and two refer to pleasurable experiences. For each card there are nine scenes that represent different possible ways of dealing with the emotional experience evoked by the card. These scenes are grouped into three categories of three scenes each – the Anxiety category (A), the Fantasy category (F) and the Reality category (R). The child is asked to complete the story drawn on the card by selecting and then placing three of these nine scenes in sequence. The categories of the scenes chosen by the child and the sequences organized with these scenes reflect the way children deal with their emotions, anxiety and pleasure, in a transitional space (Winnicott, 1971/1975) between fantasy and reality. After selecting and placing the scenes in sequence, the child tells the story that he/she has just invented. Although the majority of the studies done on the "Once upon a time..." Test have been centered on the analysis of the chosen scenes, according to their category (Anxiety, Fantasy and Reality) and their placement in sequence (in the first, second or third position), a complementary coding system was developed afterwards. This system involves the study of the arranged sequences based on the nine scenes available for each card, and not only the three categories (Pires & Fagulha, 2001). According to this system, the arranged sequences based on the nine scenes available for each card correspond to four different possible ways of facing anxiety and confronting with it. There is a strategy that represents the non-recognition of the painful emotion – Denial –, and three strategies that involve the recognition of this disturbing affect, corresponding to two distinct ways of coping with it – Operational Adaptive Strategy and Emotional Equilibration Strategy – and to one other that proves to be inefficient in dealing with it – Impossibility. The studies done with both coding systems have come to the same conclusion: the patterns of answers reflect differences in ages. As children mature they are able to master anxiety in a more active and efficient manner. In the coding system category of the scenes chosen and their position in the sequence, this developmental achievement is seen through a tendency to respond to anxious situations by choosing scenes that show either anxiety or reality in the first position of the sequence. There is also a progressive decrease in choice of anxiety scenes for story endings corresponding to an increase in the choice of reality or fantasy scenes. As children mature, fantasy scenes in first position of the sequence are less chosen because they reflect the denial of the distress reflected in the card (Fagulha, 1992, 1997, 2000) Regarding the complementary coding system sequences of scenes, the higher degree of emotional stability allows children to deal with anxious situations through adaptive strategies, such us Operational Adaptive Strategy and Emotional Equilibration Strategy. Denial of the anxiety and Impossibility to deal with it are strategies less used by mature children (Pires & Fagulha, 2001) In view of these empirical data is our aim to analyze and discuss a child pattern of answers to the "Once upon a time..." Test at two different moments of her psychotherapeutic process, at treatment initiation and then again to make a decision about treatment termination. We expect to give an account of the "Once upon a time..." Test potentialities to the objective evaluation of the results of child psychotherapy

Study of the Portuguese version of the Center for Epidemiologic Studies Depression Scale (CES-D)

The CES-D is a depression scale designed to measure depressive symptomatology in the general population. The authors developed a Portuguese version of this scale. This article presents the results of the three studies carried out with this version. These results support the reliability and the validity of the scale. The CES-D proved to be sensitive to variations in the intensity of depressive symptomatology and can be used in epidemiological studies or as a screening instrument in a clinical setting. Sex does have some influence on the values of sensitivity and specificity but the educational level has a greater influence on scores: subjects with a lower education level tend to obtain higher scores with the same level of depressive symptomatology as evaluated by the clinical interview

Anxiety Elaboration Strategies in the Response Sequences of Scenes in the “Once-Upon-A-Time…” Projective Technique

In this study we proceed to the identification of four anxiety elaboration strategies in the response sequences of scenes in the “Once-upon-a-time…” projective technique. A strategy which corresponds to the negation of the anxiety emotion – Negation –, two strategies which represent different means of positive dealing with anxiety – Operational Adaptative Strategy and Emotional Equilibration Strategy –, and a fourth strategy which represents the failure of the elaboration of this emotion – Impossibility – were conceived. In a sample of 100 children, from six to ten years old, without identified psychological difficulties, the evolution of the four strategies was studied according to their age and expressiveness in each of the seven cards of the “Once-upon-a-time…” technique. The process of growing implies an increase of the adaptative strategies – Operational Adaptative Strategy and Emotional Equilibration Strategy – and a decrease of the Negation and Impossibility. These findings were expected in theory and support the validation of the anxiety elaboration strategies that have been conceived. Comparing these results with those of 30 neglected children, from six to ten years old, whose emotional difficulties lead to their attendance at a Psychological Service, it was expected that, in this latter group of children, the adaptative strategies would be lower and the Negation and Impossibility of dealing with anxiety would be higher. There aren’t meaningful differences in the results of the two groups, although the neglected childrens’ group uses slightly more the Negation than the other group. Limitations of this second study, partly due to the low number of subjects, might have contributed to these results. It is our belief that this study improves the interpretative process of the “Once-upon-a-time…” technique and may contribute for a new branch of studies regarding this technique.Centro de Psicometria e de Psicologia da Educaçã

A prova «Era uma Vez» : Uma nova prova projectiva para crianças

A prova «Era uma yez ... » é uma nova técnica projectiva para crianças. É uma prova de completamento de histórias, que são apresentadas em três cenas de banda desenhada. Para completar a história a criança tem à sua disposição nove cenas desenhadas, entre as quais deverá escolher três e organizá-las em sequência. As nove cenas estão agrupadas em três categorias: Aflição, Fantasia e Realidade. A prova tem como objectivo descrever o modo como as crianças elaboram a ansiedade e o prazer, estados afectivos fundamentais no desenvolvimento psicológico. A autora apresenta as teorias de referência para a construção da prova e descreve o seu material e forma de aplicação. Apresenta-se um estudo inicial, com uma amostra de 162 crianças, entre 5-9 anos, que permitiu conhecer a reacção das crianças à prova, características das respostas, etc. Um outro estudo, com uma amostra de 245 crianças entre 6-8 anos, incidiu sobre a caracterização do padrão de respostas (categoria de cena escolhida/ posição na sequência). Um estudo com três grupos de crianças (agressivas, ansiosas e isoladas) revelou a possibilidade de diferenciar, a nível estatístico, as respostas dos três grupos, entre si e em relação ao grupo de controlo.ABSTRACT: The projective test «Era uma vez...» (Once upon a time ...) is a new projective technique for chiidren involving story completion. The stories are presented in three cartoon episodes, and the child must choose from among nine small scenes and put them in sequence to tell a story; these scenes differ in their characteristics: either they represent anxiety, fantasy, or reality possible outcomes. The test aims to describe how children elaborate emotions, mainly anxiety and pleasure, that are fundamental affects in psychological adaptation. The author presents the theoretical background of the test. The characteristics of the material and application are described. The test was initially studied with a group of 162 children, from 5-9 years old. It focused the children’s reaction to the test situation, the variability of the choice of the pictures, etc. The test was also studied with a group of 245 children, 6-8 years old, to characterize the frequency with which the different category scenes were chosen according to its placement in the sequence. The author also presents a study with three groups of children with aggressive, anxious and isolated behavior. The results indicated that the three groups could be statistically differentiated from each other and from the control group

A prova era uma vez... : uma prova projectiva para crianças

Tese de doutoramento em Psicologia (Psicologia Clínica), apresentada à Universidade de Lisboa através da Faculdade de Psicologia e de Ciências da Educação, 1992No exercício da minha actividade profissional, como psicóloga e como docente que colabora na formação de psicólogo, sempre me interessou o trabalho com crianças. Trata-se de um campo vasto e diversificado, em que as vertentes de avaliação e apoio psicológicos se apresentam complementares e mutuamente enriquecedoras. Se é certo que uma intervenção terapêutica necessita sempre de uma base prévia de avaliação, primeiro passo esclarecedor e orientador de qualquer decisão, foi a prática do apoio psicológico, na orientação dinâmica, que me motivou na procura de uma forma de avaliação com características da actividade lúdica e que pudesse constituir um instrumento de fácil administração e interpretação. Brincando com crianças, tive a "ilusão" de poder criar uma situação de prova psicológica, estandardizada no seu modo de apresentação, administração e interpretação, que permitisse revelar a forma como a criança elabora as suas emoções, desejos e experiências, entre a fantasia e a realidade. Procurei dar forma a esta ideia através da criação de histórias de banda desenhada, que representam episódios críticos, comuns na vida das crianças (perder-se, ter um pesadelo, etc.). A criança deverá dar continuação à história, escolhendo três, entre nove pequenas cenas, no mesmo estilo de banda desenhada. Entre as nove cenas referidas, três representam situações em que a personagem está aflita; três representam situações em que a personagem encontra, na fantasia, uma forma de aliviar a tensão; três representam modos realistas de encarar a dificuldade, ou tentar resolvê-la. Designei a prova por "Era uma vez…" (…

Relationships between the perceived quality of life and the personality styles measured with the The Millon Index of Personality Styles Revised (MIPS-R)

This exploratory study aims to determine whether the personality styles measured with the Portuguese adaptation of Millon Index of Personality Styles Revised, MIPS-R affect the perceived quality of life. The MIPS-R is a theory-based inventory that measures 24 personality styles in normally functioning adults. Life satisfaction was measured with the Portuguese version of the Quality of Life Inventory, QOLI (Fagulha, Duarte & Miranda, 2000). It refers to a person’s subjective evaluation of the degree to which his/her most important needs, goals and wishes have been fulfilled. This study was carried out with a sample of 43 college students, 36 females (age mean = 19,7; SD = 3,1) and 7 males (age mean = 27,4; SD = 11,4). Based on the participants’ overall life satisfaction score three groups were defined: (1) Low/Very Low quality of life, (2) Average quality of life, (3) High quality of life. Discriminant Factor Analysis (DFA) and the Kruskal-Wallis Test were used to identify the styles that most differentiate these groups and to compare each style in the groups. The Other-Nurturing style is the one that best differentiates the groups. DFA results will be further exploited. Considering the Kruskal-Wallis Test, differences are observed in the Pleasure-Enhancing (p=.006), the Actively Modifying (p=.002), the Gregarious/Outgoing (p=.012), the Passively Accommodating (p=.027), the Asocial/Withdrawing (p=.036), the Unconventional/Dissenting (p=.041) and in the Dissatisfied/Complaining (p=.019) styles. Multiple comparisons were used to compare these styles in the groups. The authors believe that the discussion of these results will provide a better understanding of the MIPS-R.Instituto de Psicologia das Relações Humana

The Millon Index of Personality Styles Revised (MIPS-R) in Portugal: Gender Differences

This study aims to determine whether males and females differ in the personality styles mesured with the Portuguese version of the Millon Index of Personality Styles Revised, MIPS-R (Millon, 2004). The MIPS-R is a 180-item, True/False inventory designed to measure personality styles of normally functioning adults between the ages of 18 and 65+. It is a theory-based inventory, grounded in biosocial and evolutionary theory, and comprises 12 pairs of scales organized into three main areas: Motivating Styles – that assess what purposes and goals direct individual’s behaviour; Thinking Styles – that describe cognitive processes, the sources employed to gather knowledge about life and the ways in which people evaluate and organize experiences, once apprehended; Behaving Styles – that represent different ways of interacting with others. Gender differences in some personality styles are theoretically expected (Millon, 2004) and have been empirically confirmed (Millon, 1994, 2004; Sánchez López, et al., 2001). This study was carried out with a sample of 280 participants, 120 males (age average = 35,85; standard deviation = 11,44) and 160 females (age average = 34,63; standard deviation = 10,93). Preliminary data analysis point to significant differences between men and women in the Other-Nurturing Style (p=.006), the Internally Focused Style (p=.036), the Thought-Guided Style (p=.000), the Feeling-Guided Style (p=.003), the Unconventional/Dissenting Style (p=.013) and the Cooperative/Agreeing Style (p=.012). The are compared with those obtained with the original test (Millon, 1994,2004) and its spanish adaptation (Sánchez López, et al., 2001).Instituto de Psicologia das Relações Humanas, Centro de Psicometria e de Psicologia da Educaçã

Estratégias de elaboração da ansiedade na Prova “Era uma vez...”: Contributos para a diferenciação de crianças com funcionamentos psicológicos distintos

Quatro estratégias de elaboração da ansiedade, identificadas nas respostas sequências de cenas à Prova “Era uma vez...”, foram utilizadas para descrever o movimento interno de elaboração das emoções nas respostas de duas crianças de 10 anos, com e sem perturbação emocional identificada. A estratégia Negação traduz um movimento interno que impede o reconhecimento dos aspectos perturbadores da situação, defendendo o Ego da experiência de ansiedade. As restantes estratégias caracterizam-se pela possibilidade de reconhecimento da ansiedade. Na Estratégia Adaptativa Operacional e na Estratégia com Equilibração Emocional, a situação ansiogénea é resolvida, respectivamente, através do recurso à acção e da utilização criativa da fantasia. A Impossibilidade traduz o insucesso na elaboração adaptativa da ansiedade. Estudos prévios sobre a comparação entre as estratégias de elaboração da ansiedade utilizadas por crianças com diferentes capacidades de adaptação psicológica, sugerem um aumento da utilização da Negação e da Impossibilidade com a idade, nas crianças com perturbação emocional (Pires & Fagulha, 2003/2004). Através da apresentação de algumas respostas à Prova “Era uma vez...”, ilustram-se as diferentes possibilidades de elaboração da experiência ansiosa das duas crianças mencionadas, reconhecendo-se a utilidade clínica das estratégias identificadas na diferenciação de crianças com funcionamentos psicológicos distintos

Estratégias de Elaboração da Ansiedade nas Respostas Sequências de Cenas na Prova Projectiva para Crianças “Era uma vez...”

Procedeu-se à validação de quatro modalidades de elaboração da ansiedade identificadas nas sequências de cenas organizadas para dar continuidade às histórias dos cartões da Prova "Era uma vez...". Definiu-se uma modalidade que traduz o não reconhecimento da ansiedade – Negação – e três modalidades em que este afecto é reconhecido: a Estratégia Adaptativa Operacional e a Estratégia com Equilibração Emocional correspondem a duas formas adaptativas, mas distintas, de elaborar a ansiedade; a Impossibilidade traduz o insucesso na elaboração adaptativa da ansiedade. Procedeu-se à descrição das modalidades mais utilizadas em cada cartão da prova e ao estudo da sua evolução, dos 6 aos 10 anos, numa amostra de 100 crianças sem perturbação emocional identificada. A hipótese de que, com o desenvolvimento, a frequência de utilização das estratégias adaptativas aumenta e as frequências de utilização da Impossibilidade e da Negação diminuem, foi confirmada. Procedeu-se à descrição destas modalidades numa amostra de 30 crianças, dos 6 aos 10 anos, com perturbação emocional identificada. Previa-se que estas crianças utilizassem um maior número de estratégias Negação e Impossibilidade, em relação às crianças sem perturbação emocional identificada e, simultaneamente, um menor número de estratégias adaptativas. A comparação entre os resultados obtidos nos dois grupos não apresenta diferenças significativas.We proceed to the identification of four anxiety elaboration strategies in the responses sequences of scenes in the “Once-upon-a-time…” test. A strategy which corresponds to the denial of the anxiety – Denial –, two strategies which represent different means of positive dealing with anxiety – Operational Adaptative Strategy and Emotional Equilibration Strategy –, and a fourth strategy which represents the failure of the elaboration of this emotion – Impossibility – were conceived. In a sample of 100 children, with ages ranging from six to ten years, without psychological difficulties, the evolution of the strategies was studied according to their age and expressiveness in each card of the "Once-upon-a-time…" test. The process of growing implies an increase of the adaptative strategies – Operational Adaptative Strategy and Emotional Equilibration Strategy – and a decrease of the Denial and Impossibility. These findings were expected in theory and support the validation of the strategies that have been conceived. Comparing these results with those of a sample of 30 children, six to ten years old, with psychological difficulties, it was expected that, in this latter group, the adaptative strategies would be lower and the Denial and Impossibility would be higher. There aren’t meaningful differences between the results of the two groups

Intervenção em uma ruína no Douro - tradição e contemporaneidade

A presente Dissertação de Mestrado Intervenção em uma ruína no Douro - Tradição econtemporaneidade faz uma abordagem ao problema da intervenção arquitectónica empreexistências.A motivação deste trabalho decorreu da oportunidade de desenhar uma pequenacasa dentro de uma ruína, num terreno de família no Douro, que viesse revitalizar e"agitar" o silêncio de um lugar abandonado.Através de uma análise e interpretação essencialmente focadas nos conceitos de continuidadee ruptura no âmbito da História da Arquitectura recente, reavalia-se a críticaprimitiva do Movimento Moderno, demonstrando que na verdade este não "rompeu"com o passado nem desvalorizou a história da cidade.O desenho de um projecto para a reconversão da ruína materializa o fio condutorentre Teoria, Referências e Projecto, procurando um equilíbrio entre tradição e contemporaneidade,que seja capaz de responder à complexidade das questões levantadasdurante o seu desenvolvimento. Surge, assim, a vontade de continuar a obra existente,aproveitando a sua utilidade para o presente, considerando e balançando as suas condiçõesnecessárias.A solução apresentada não é uma resposta definitiva e "fechada" para resolver o problemadesta ruína, mas antes um caminho possível para intervir numa preexistênciaequilibrando Continuidade e Ruptura.Este trabalho pretende fazer uma reflexão que encontre respostas fundamentadaspara os novos desafios e circunstâncias do presente, mostrando que conservar e renovarsão atitudes que podem coexistir simultaneamente."(...) a arquitectura dos próximos anos será marcada pela prática da recuperação. Recuperaçãoe criação serão complemento e não especialidades passíveis de tratamentos autónomos.(...) Reconhecer-se-á que a linguagem se adapta à realidade para lhe dar forma.(...) Os instrumentos de reconhecimento do real chamam-se História, a arte de construir atransformação chama-se Arquitectura."The present Master's Dissertation "Intervention in a ruin in Douro - tradition andcontemporaneity" takes an approach to the issue of architectural interventions in pre-existences.The motivation of this work was the opportunity to design a small house in a familyplot in Douro, that would revitalize and "disturb" the silence of an abandoned place.Through an analysis and interpretation mainly focused on the concepts of continuityand rupture within the History of recent Architecture, it reavaluates the early criticismabout the Modern Movement, demonstrating that in fact it didn't break with the pastneither underestimated its legacy and the history of the city.The design of a project to recover a house in ruins, whose purpose is its reuse, materializesthe common thread between Theory, References and Project, looking up fora balance between tradition and contemporaneity, which may be able to respond to thecomplexity of the issues raised during its development. It came up the desire of continuingthe existent, taking advantage of its utility to the present, always considering andbalancing the necessary conditions both of the pre-existence and the new needs.The solution purposed is not a "closed" or definite answer to solve the problems ofthis ruin, but rather a possible way to intervene in a pre-existence, balancing Continuityand Rupture.This work intends to make a reflection that finds reasoned responses to the newchallenges and circumstances of the present, showing that conserving and renewing areattitudes that can coexist simultaneously."(...) the architecture of the coming years will be marked by the practice of recovery.Recovery and creation will be complementary and not specialties that can be autonomouslytreated. (...) It will be recognized that the language adapts itself to reality to give it a form.(...) The instruments of recognition of the real are called History, the art of constructingtransformation is called Architecture.