Impacto subjetivo del éxito y fracaso terapéutico sobre las vivencias de bienestar/malestar del terapeuta

Tesis doctoralHay amplia evidencia q ue las diferencias en los resultados terapéuticos entre tipos de tratamiento se deben principalmente al efecto terapeuta, es decir, algunos terapeutas son más efectivos que otros (Wampold, 2001; Wampold Imel, 2015), pero poco se sabe de la razón de estas diferencias. En el campo de la investigación en éxito y fracaso terapéutico, tanto en investigaciones de resultado como también de proceso, se observa este mismo vacío, siendo escaso el conocimiento en torno a la experiencia del terapeuta y cómo ésta se a rticula a lo largo de su desarrollo profesional. En términos del bienestar/malestar constructos tales como burnout, desgaste por empatía y fatiga por compasión (Figley, 1995, 2002; McCann Pearlman, 1990) han sido ampliamente estudiados, sin embargo hay muy poca evidencia en torno a cómo el terapeuta va cambiando en base a las experiencias cotidianas de hacer terapia. En la presente investigación s se buscó indagar en el impacto que tiene el quehacer profesional en los terapeutas, teniendo por objetivo reconstruir la relación entre las experiencias de éxito y fracaso y el bienestar/malestar subjetivo en terapeutas chilenos y alemanes en diferentes etapas de su desarrollo profesional. Esta investigación de metodología cualitativa y de corte transversal utilizó el método de análisis narrativo orientado al descubrimiento (Duarte, Fischersworring, Martínez & Tomicic, 2017). Se realizaron dos estudios con perspectivas complementarias, con un total de 35 entrevistas realizadas a terapeutas chilenos y alemanes en diferentes etapas de su desarrollo profesional. El desarrollo profesional se produce en gran medida en torno a las experiencias del terapeuta vinculadas al quehacer terapéutico y al manejo de éstas. Tanto en las experiencias de éxito y fracaso, como en el manejo que se le da, se manifiesta el aspecto cultural del desarrollo profesional; en tanto los contextos en los que se realizan las experiencias con los pacientes se vinculan al desarrollo de una identidad profesional. Por otro lado, las vivencias de bienestar y malestar están vinculadas a las experiencias de trabajo con los pacientes y a la relación con los mismos, siendo la percepción de cambio que tiene el terapeuta del paciente un elemento central. Los resultados se discuten a la luz de la evidencia tanto en torno al desarrollo profesional como también de los efectos del terapeuta.There is ample evidence that differences in the therapeutic results between types of treatment are mainly due to the therapist effect, that is, some therapists are more effective than others (Wampold, 2001; Wampold & Imel, 2015), but little is known about the reason of these differences. In outcome and process research about success and failure in therapy, the same gap is observed, with little knowledge about the therapist experiences and how it is articulated throughout a professional development. In terms of well-being and discomfort, constructs such as burnout and compassion fatigue (Figley, 1995, 2002; McCann & Pearlman, 1990) have been widely studied, however, there is very little evidence about how the therapist changes by every experiences of doing therapy. In the present study, we sought to investigate the impact that professional work has on therapists, with the purpose of reconstructing the relationship between success and failure experiences and subjective well-being and discomfort, in Chilean and German therapists at different stages of their professional development. The present research had a qualitative and cross-sectional design, using the Discovery-oriented Narrative Analysis Method (Duarte, Fischersworring, Martínez & Tomicic, 2017). Two studies were carried out with complementary perspectives, with a total of 35 interviews conducted with Chilean and German therapists at different stages of their professional development. Professional development takes place largely around the therapist’s experiences related to therapeutic work and the management of these experiences. The cultural aspects of professional development are manifested in the experiences of success and failure in therapy and in the management of them; while the development of a professional identity is linked to diverse contexts in which the experiences with clients occurs. On the other hand, the experiences of well-being and discomfort are linked to working experiences with clients and also to the relationship with them, being a central element for wellbeing the therapist’s perception of change by the client. The results are discussed in light of the evidence regarding both professional development and therapist effects

“I couldn’t change the past; the answer wasn’t there”: A case study on the subjective construction of psychotherapeutic change of a patient with a Borderline Personality Disorder diagnosis and her therapist

© 2017 Society for Psychotherapy Research Background: Qualitative research has provided knowledge about the subjective experiences of therapists and patients regarding the psychotherapy process and its results. Only few studies have attempted to integrate both perspectives, considering the influence of a patient’s characteristics and diagnosis in the construction of this experience. Aim: To identify aspects of psychotherapy that contribute to therapeutic change based on the experience of a patient and her therapist, and to construct an integrated comprehension of the change process of a patient with Borderline Personality Disorder. Method: A single case was used to carry out a qualitative analysis of follow-up interviews of the participants of a long-term psychotherapy. Two qualitative approaches were combined into a model entitled “Discovery-Oriented Biographical Analysis” to reconstruct an integrated narrative. Results: This method yielded an integrated narrative organized into fou

“I couldn’t change the past; the answer wasn’t there”: A case study on the subjective construction of psychotherapeutic change of a patient with a Borderline Personality Disorder diagnosis and her therapist

© 2017, © 2017 Society for Psychotherapy Research. Background: Qualitative research has provided knowledge about the subjective experiences of therapists and patients regarding the psychotherapy process and its results. Only few studies have attempted to integrate both perspectives, considering the influence of a patient’s characteristics and diagnosis in the construction of this experience. Aim: To identify aspects of psychotherapy that contribute to therapeutic change based on the experience of a patient and her therapist, and to construct an integrated comprehension of the change process of a patient with Borderline Personality Disorder. Method: A single case was used to carry out a qualitative analysis of follow-up interviews of the participants of a long-term psychotherapy. Two qualitative approaches were combined into a model entitled “Discovery-Oriented Biographical Analysis” to reconstruct an integrated narrative. Results: This method yielded an integrated narrative organized

Recognizing oneself in the encounter with others: Meaningful moments in systemic therapy for social anxiety disorder in the eyes of patients and their therapists after the end of therapy.

ObjectiveThe objective of this study is to characterize and describe meaningful moments in the context of systemic psychotherapy, from the point of view of patients and their therapists, after the end of therapy. The therapy studied is a manualized, monitored systemic therapy for social anxiety disorder.MethodSemi-structured follow-up interviews were conducted separately with five patients and their therapists (N = 10). Methodological triangulation was used: Grounded theory was used to code the transcripts as described by Charmaz. Then the passages of the selected code "meaningful moment" were evaluated using thematic comparison, in line with Meuser & Nagel.FindingsThree categories involving meaningful moments were identified: (1) meeting other patients in group therapy session, (2) therapeutic resource orientation and (3) recognizing oneself in a diagnosis or pattern of behaviour. These categories emerged as contexts related to the occurrence of meaningful moments from a subjective perspective.DiscussionMeaningful moments seem to be consistently related to the therapist input and to specific interventions or settings, both from the perspective of the patients and the therapists. Two tandems each described a coincident moment. One central aspect of all 14 moments is that the patients and therapists described patients being able to acquire another outlook on themselves