La psicoterapia: ¿oficio sin ciencia y ciencia sin oficio?/ psychotherapy: practice without science or science without practice?

En este ensayo se analiza el persistente divorcio entre la práctica clínica y la investigación en psicoterapia. Se examinan las razones subyacentes al problema en ambos contextos. En cuanto a la práctica clínica, se discuten las características de la enseñanza de la psicoterapia, las escuelas terapéuticas como comunidades y los temores a la investigación. En lo que atañe a la investigación en psicoterapia, se analizan los resultados que ofrece esta sobre la efectividad de la psicoterapia, sobre la alianza terapéutica y sobre elementos del proceso. El ensayo concluye con la presentación de algunas transformaciones de la investigación y su difusión que pueden aportar al acercamiento entre oficio y ciencia en psicoterapia

Dynamics of subjective change in psychotherapy. A Comment on the Paper "Dynamics of sense-making and development of the narrative in the clinical exchange" by Alessandro Gennaro, Miguel Gonçalves, Inês Mendes, António Ribeiro, & Sergio Salvatore

The following comment has been divided into four sections that present a critical discussion on: (1) the theoretical background of the paper; (2) the two methods used: Discourse Flow Analysis (DFA) and Innovative Moments Coding System (IMCS); (3) results; and (4) conclusions

Soziale Repräsentation psychologischer Intervention unter Armutsbedingungen

Die wichtigsten Ergebnisse einer qualitativen Studie über soziale Repräsentationen professioneller Hilfsangebote bei psychischen Problemen in einem als arm gekennzeichneten Bezirk von Santiago de Chile werden dargestellt. Zunächst werden unterschiedliche Definitionen und Merkmale von Armut diskutiert und Daten über das Ausmaß der Armut in Chile vorgestellt. Dann wird die Verbindung zwischen Armut und psychologischen Interventionen beleuchtet in Bezug auf die Verteilung psychischer Störungen und als Diskussion der Schwierigkeiten, mit denen psychologische Hilfe in armen Bevölkerungsgruppen verbunden ist. Bezüglich der vorgestellten Ergebnisse, die auf der Transkription von 17 Interviews basieren, wird zwischen Inhalten und Einflussquellen unterschieden. Inhaltlich beziehen sich die Ergebnisse auf die Repräsentation der psychologischen Hilfe, die Konzeptualisierung der eigenen Probleme, insbesondere jener, die die Hilfesuche rechtfertigen, und die Repräsentation des Zugangs zu den Hilfsangeboten. Als Einflussquelle auf die sozialen Repräsentationen sind die Massenmedien sowie die eigene Erfahrung mit professioneller Hilfe oder die von Menschen aus dem engeren sozialen Umfeld zu sehen

The therapeutic relationship and change processes in child psychotherapy: a qualitative, longitudinal study of the views of children, parents and therapists

Through the perspectives of children, parents and therapists, this study explored the therapeutic relationship as a change facilitator in different moments of psychotherapy. The children, parents, and therapists (N=15) who formed part of five therapeutic treatments were studied using a qualitative, longitudinal design. Thirty semi-structured interviews were done; half at the beginning and half after four months of psychotherapy. Children's drawings were incorporated, and data were analysed through grounded theory methods and qualitative analysis guidelines for drawings. Participants identified several aspects of the therapeutic relationship as change facilitators. From the first encounters, the therapists' close and adaptable attitude promoted an improved motivation for psychotherapy and enhanced engagement among children and parents. Later in the process, a positive, child-centred and affective therapeutic relationship fostered the child's trust with the therapist as well as a positive relational experience, promoting associated changes in children and the development of socio-affective tools. Parents and therapists saw their own relationship as a change facilitator, as well as a broader understanding in parents of their children and an improved relationship with them. Parent's and child's changes helped each other. Specific and common aspects between participants' perspectives provided a richer understanding of the studied phenomena. This study supports the view that a positive therapeutic relationship facilitates early changes in the motivation of children and parents, and provides them with a healing, relational experience as it develops. A positive parent-therapist relationship is also key for changes to further progress

A Microanalytical Look at Mutual Regulation in Psychotherapeutic Dialogue: Dialogic Discourse Analysis (DDA) in Episodes of Rupture of the Alliance

Objective: The psychotherapeutic process, like any intimate relationship between two human beings, involves mutual and self regulation processes that support effective communication. In psychotherapy, such regulatory processes are relevant to maintain a positive working alliance and contribute to therapeutic change. Rupture episodes in the alliance and their resolution constitute key moments in which mentioned regulatory processes are manifested.This article shows a micro-analysis of episodes of rupture of the alliance using Dialogic Discourse Analysis (DDA) to depict mutual regulation process in the psychotherapeutic dialogue. Method: The Dialogic Discourse Analysis (DDA) is a microanalytic procedure that makes it possible to identify discursive strategies associated with the processes of construction, failure and restoration of the psychotherapeutic dialogue. This analytic tool was applied to 34 episodes of rupture of the alliance taken from a long-term psychoanalytic therapy. Results: An emergent model about the discursive regulatory process in episodes of rupture of the alliance was developed, distinguishing between the overcoming and repairing processes of the alliance ruptures.Conclusion: The core issue in the resolution of ruptures seems to be regulating the tension between the participants. The way by which both repairing and overcoming processes account for two alternatives for regulating this tension is discussed. It is proposed that the strategies that are the most repairing would facilitate the occurrence of psychotherapeutic change. Additionally, the discussion focuses on the value of DDA as a microanalytical methodology that makes it possible to comprehensively account for these processes. Â

Depression and attachment: how do personality styles and social support influence this relation?

The purpose of this study is to improve the current understanding of the relation between depression and attachment through the evaluation of the role of personality styles (dependent vs self-critical) and social support in this association. These variables were studied in a clinical sample of 70 depressed outpatients (83% women; M=41.47 years, SD=12.91). Depressive symptomatology was assessed through the Beck Depression Inventory, adult attachment through the Experiences in Close Relationships Scale, social support through the Social Support Questionnaire and dependency and self-criticism through the Depressive Experiences Questionnaire. Mediational and moderation regression analyses were performed. Results show that the association between the dimensions of attachment (anxiety and avoidance) and depression was partially mediated by self-criticism. Furthermore, results demonstrate the role of social support as a moderating variable: when the level of satisfaction with social support was low and the anxiety dimension in the attachment scale was high, as avoidance increased, depressive symptoms increased as well. Results are discussed in relation to their importance for understanding the complex interplay of the variables involved in depression

Beyond self-criticism and dependency: structural functioning of depressive patients and its treatment

Van Praag states that the underlying psychic dysfunctions in psychopathology must be evaluated (and treated) in patient-centered treatments. In line with this idea, Blatt and colleagues propose the concept of self-critical (introjective) and dependent (anaclitic) functioning. The research program Millennium Initiative has studied self-critical and dependent functioning from different perspectives. The general aim of this paper is to share the results of the program that have contributed to clinical psychotherapeutic thinking. Its first specific aim is to summarize results reported elsewhere that support the predictive value of introjective and anaclitic functioning (Part I), while its second specific aim is to report original data that account for the structural functioning of personality underlying these two constructs (Part II). The results (Part I) show that self-critical functioning is associated with greater reactivity to stress (according to cortisol level in stress tasks) and less subjective awareness of stress, reduced performance in general tasks, and lower mentalization (errors in reading faces); also, patients with introjective (self-critical) depression receiving psychotherapy have more symptoms at onset, higher dropout rates, and poorer response to interventions than anaclitic (dependent) patients. Higher self-criticism was associated with higher depression scores; also, when comparing clinical and nonclinical samples, the latter showed less self-criticism. Therefore, self-critical functioning represents a challenge for researchers and clinicians. The evaluation of the structural functioning of personality showed (Part II) that self-critical functioning is associated with less integrated levels of structure and more depressive symptoms. This functioning is underlain by vulnerabilities in the abilities regulating object relationships and attachments to internal objects. Dependent functioning is associated with vulnerabilities in self-perception, self-regulation, and attachments to external objects. The psychotherapeutic implications of these results are discussed, paying special attention to aspects connected with structure-oriented psychotherapy

Introjective Individuals Tend Toward Anhedonia: Self-Report and Experimental Evidence

A broad line of research has conceptualized personality based on the interaction of two aspects: interpersonal relatedness and self-definition. This theoretical corpus understands these functions as two poles according to the patterns of interaction and relevance in personality. Additionally, the exacerbation of one of these poles generates a psychopathological model that identifies three types of depressive experience: anaclitic, introjective, or mixed pattern. Understanding the lack of interest as a key symptom of depression, this experiment evaluates a relation for anhedonia and the polarities model configuration using an empirical and experimental protocol. We tested 177 individuals using the Beck Depression Inventory (BDI) subscale for anhedonia and a visual discrimination task with a specific reward system, which was implemented to study reinforcement sensitivity. Participants were classified into four groups by the polarities of experience model. The subscale's results showed that individuals with an introjective character exhibited an enhanced anhedonic symptomatology but no co-occurrence of this evidence on the experimental protocol. These results empirically support the two polarities of the depressive personality model and raise new questions regarding how to experimentally test this relation

Diálogos y autorreferencia: procesos de cambio en psicoterapia desde la perspectiva de los actos de habla

El presente artículo es producto del estudio realizado en el marco de la investigación de proceso en psicoterapia basada en los Indicadores de Cambio Genéricos (Krause et al., 2006a). Junto con la Teoría de los Actos de Habla (Searle, 2002; Aristegui et al., 2005) se propone utilizar el modelo del self dialógico (Hermans, 1996; Valsiner, 2007) como dispositivo para caracterizar y diferenciar los episodios de cambio y estancamiento en la conversación terapéutica. La unidad de análisis del estudio está constituida por extractos de dos terapias de distintas orientaciones teóricas con episodios de cambio y estancamiento previamente identificados a través de los indicadores derivados a partir de la teoría del cambio subjetivo. El estudio de los episodios de cambio señala características dialógicas de la conversación terapéutica que suponen un juego de lenguaje autorreferencial en el cual terapeuta y consultante van construyendo una descripción de la posición del yo (sujeto) que se compromete con acciones intencionales ilocutivas. El estudio y comparación de los episodios de cambio con episodios de estancamiento integra en la discusión las distinciones foco de la experiencia en primera persona y simetría veritativa aplicadas a la noción de performatividad-autorreferencial y la nociones dialógicoautodialógico, según la teoría del self dialógico (Hermans, 1996; Valsiner, 2007; Anderson, 1999)