António Branco Vasco

Alexithymia and Emotional Processing: A Mediation Model

OBJECTIVE Although alexithymia has been associated with difficulties in emotional regulation, both constructs are complex and this association remains unclear. This research attempts to study the relation between both constructs to identify better ways to guide clinical intervention. METHOD Emotion awareness, differentiation, and regulation were tested as mediators of the associations between alexithymia and severity of symptoms. The model was tested in a clinical (121 participants) and a nonclinical sample (188 participants). RESULTS Mediation effects were found in both samples with respect to different alexithymia factors, with the effects being higher in the clinical sample. CONCLUSION Emotional awareness and emotional differentiation mediate the relationship between alexithymia and emotion regulation. The similarities between samples suggest that emotional processing may be better thought of as being on a continuum. Being aware of the differential effect each alexithymia factor has on emotional processing may be helpful to guide intervention.

Tracking and understanding phase progression in Lisa's case

This study adds a phase-by-phase perspective to the well-known, and thoroughly analysed on a moment-by-moment basis, case of Lisa. The aim is to see whether this phase-by-phase analysis adds anything valuable to the understanding of the processes of change in this case and the therapeutic processes in general. In this good-outcome case study, a team of raters integrated the temporal sequencing phase component of the Paradigmatic Complementarity Metamodel (PCM) with a moment-by-moment tracking method-the Developmental Analysis of Psychotherapy Process Method (DAPP)-to analyse what occurred along the process that could explain the phase transitions and consolidations observed and how the therapist facilitated them. We illustrate and explain the therapeutic progression with therapeutic interactions from the dyad. The results suggest that Lisa evolved in accordance with the sequence of phases proposed by the PCM until phase 4 (out of 7). However, only phase 2 gains show evidence of structural consolidation. The sequence of phases proposed by the PCM seems to represent a natural progression for patients throughout the therapeutic process, and the consideration of a phase-by-phase map in analysing and thinking of therapeutic cases may be a valuable tool regarding clinical decision making.

Alexithymia and emotional processing: a longitudinal mixed methods research

Alexithymia has been associated with poor outcomes in psychotherapy. This association has been attributed to a difficulty in patients processing emotions and engaging in emotional tasks. The possibility of alexithymia being modified by psychotherapy remains a topic of great debate but with little empirical research. In this study a mixed methods longitudinal design was used to better understand alexithymia, emotional processing and change process in psychotherapy. Twelve clients, five with alexithymia, were studied considering the development of alexithymia, emotional awareness, differentiation, regulation and severity of symptoms. The reliable change index was used to interpret the evolution of those emotional variables’ scores for each case and thematic analysis was used to analyze individual interviews. Thematic analysis generated several themes, organized in two broad domains: i) perception of emotions and ii) description of change. The three alexithymic patients that changed in alexithymia also changed in at least one of the emotional variables – lack of emotional awareness, emotion differentiation or emotion regulation. Generally, alexithymic patients were able to accomplish change in psychotherapy although they had a tendency to focus on physical complaints, describe changes in a more rational rather than emotional way and present vaguer descriptions of their problems. These results point that alexithymia may change through therapy and reinforces that those changes are associated with improved emotional processing.

Alexithymia and therapeutic alliance: a multiple case study comparing good and poor outcome cases

Alexithymia has been associated with poor outcomes in psychotherapy. This association has been attributed to a difficulty in patients expressing emotions, engaging in emotional tasks and also poor therapeutic alliances. This study aims to better understand alexithymic patients in psychotherapy. A multiple case study design was used. Cases were selected from a larger research project considering their alexithymia level and outcome status, based on the reliable change index and the client perspective on change. Four cases are presented: with and without alexithymia with good and poor outcome. The therapeutic alliance was included as a process measure, evaluated from both client and therapist. At the end a semi structured interview was conducted with both participants, individually. The analysis concerned the integration and triangulation of the therapist and client experience for each case. Each patient was briefly presented and then a focus was made regarding the perception of both participants on the therapeutic alliance and the emotional processing and change process of the client. Both alexithymic cases and the non-alexithymic poor outcome case showed difficulties in the therapeutic alliance, especially from the perspective of the therapist. In these cases, emotional impairments may have contributed to a poor therapeutic alliance, impacting on the outcome. We suggest that a great focus on the therapeutic alliance with alexithymic patients may increase the quality of treatment and it may be more useful for case conceptualization to consider each feature of the alexithymia construct individual.

Analysing phase progression in Susan's case

This study adds a phase-by-phase perspective to the case of Susan, with the aim of better understanding the processes of change in this therapeutic case. A team of 3 raters integrated the sequential phases of the Paradigmatic Complementarity Metamodel with a moment-by-moment tracking method-the Developmental Analysis of Psychotherapy Process method-to analyse this therapeutic process and clarify what happened throughout that may explain phase gains and how the therapist facilitated them. The results suggest that Susan evolved in accordance with the sequence of phases proposed by the Paradigmatic Complementarity Metamodel. We illustrate and explain this with therapeutic interactions representative of Susans development within the evolving therapeutic process. This case study is the third of a series intended to contribute towards the optimization of clinical decisions in therapeutic processes by identifying markers of phase progression and assessing the value of the therapeutic interventions offered.

Psicoterapeutas portugueses: Características demográficas, actividades profissionais, perspectivas teóricas e satisfação com o treino e com a carreira

The intention at the present paper, based on a study conducted via mailed questionnaires, is to sketch a detailed characterization of the Portuguese psychotherapeutic community, contrasting it with its North American, British and French counterparts. This characterization is focused on four sets of variables: (1) demographic characteristics; (2) professional activities; (3) theoretical perspectives and (4) satisfaction with training and career. Comparisons regarding gender, clinical experience, and theoretical orientation are also made.

Terapias breves numa perspectiva cognitivo-comportamental

Depois de abordarem a evolucao historica do conceito de «terapias breves» e de o caracterizarem tanto em termos de conteudos como em termos de limites temporais, os autores referem-se a alguns dos problemas metodologicos associados a questao da sua eficacia terapeutica. Salienta-se que as caracteristicas estruturais das terapias cognitivo-comportamentais (focus, metodologias de intervencao e limites temporais) permitem coloca-las dentro da categoria de terapias breves bem como diferencia-las de outros tipos de terapia igualmente breves (i.e., psicodinâmicas e comportamentais). Finaliza-se, salientando que nos modelos epistemologicos de terapia cognitiva as decisoes relativas a durabilidade do processo sao um resultado das caracteristicas e objectivos dos clientes dado entender-se que o processo terapeutico e um espaco de crescimento pessoal no sentido da «auto-gestao» psicologica daqueles.