Carolina Altimir

The evolution of therapeutic change studied through generic change indicators

Abstract Ongoing change and therapeutic outcome were studied in five psychotherapeutic processes: three brief psychodynamic therapies, one social constructionist family therapy, and one group therapy of a comprehensive nature for drug abuse patients. Using qualitative methodology, in-session and extrasession change moments were identified and classified in a hierarchy of generic change indicators. Additionally, all patients were administered Lamberts Outcome Questionnaire. Results show that (a) extrasession change moments are more frequent toward the end of therapy, (b) therapy types differ in the frequency of some change indicators but not others, and (c) change indicators observed at the beginning of therapy are of lower level than those occurring at the end.

Language and therapeutic change: A speech acts analysis

Abstract Drawing on the speech acts theory, a linguistic pattern was identified that could be expected to be associated to therapeutic change, characterized by being uttered in the first person singular and present indicative, and by being self-referential in its propositional content. The frequency of the pattern was examined among verbalizations defined as change moments in three therapies with different theoretical orientation. Results show that the majority of change moments have the specified pattern, and that this pattern is significantly more frequent in change moments than in random non-change-related verbalizations, and so, it does not pertain to therapeutic conversation in general. Implications are discussed concerning the possibility of using the linguistic pattern as an additional and complementary criterion in the identification of moments of change in the therapeutic process.

A cost-effectiveness evaluation of a home visit program for adolescent mothers

A home visit intervention program for adolescents throughout their pregnancy and during the early stages of motherhood was evaluated. The participants (N = 90) were part of a larger group of adolescents treated in two health centers in a poor neighborhood in Santiago, Chile. The program was carried out by volunteer community health monitors and evaluated through an experimental, randomized, controlled clinical trial. Cost-effectiveness was examined in comparison with standard health care. Results show higher scores for the intervention group on the mothers’ mental health and nutritional state, as well as on the children’s levels of linguistic development.

Analysis of verbalized emotions in the psychotherapeutic dialogue during change episodes

Abstract As described by many theorists, emotional expressions contribute to the activation and regulation of personal emotional experiences and communicate something about internal states and intentions. These emotional expressions can be observed in the words used in our speech and nonverbal behaviors, even when nonverbal behaviors are synchronized to ones own speech or to the speech of others. Using a quantitative and qualitative methodology, this article reports a classification of verbal emotional expressions of both psychotherapists and patients in change episodes. Assuming that the emotions loaded in linguistic contents are explicit emotions shown by emotion words, this methodology allows for a complete and differentiating assessment of affective qualities in both patients and psychotherapists during the psychotherapeutic dialogue.

Generic change indicators in therapeutic processes with different outcomes

Abstract Objectives: This paper analyzes the relationship between ongoing change and final outcome in therapies carried out in natural settings with 39 clients. Method: Ongoing change was assessed through generic change indicators (GCIs), an observational method designed to label the content of change moments by selecting one specific GCI from the sequence of 19 that covers from more rudimentary and low complexity to more elaborated and complex changes. These GCIs can also be grouped into three broad stages of change, according to their level of complexity. Productivity indicators were generated to account for the number of GCIs (total and grouped by stage) adjusted by the length of therapy and the respective individual production of GCIs. Outcome, in turn, is understood as the final result of therapy and was measured by Lamberts Outcome Questionnaire (OQ 45.2). Results: Using the Reliable Change Index of this measure, which qualifies the difference between initial and final scores, therapies were grouped into “good outcome” and “poor outcome” cases. Findings indicate that therapies with good final outcome show a greater presence of Stage III GCIs during the process. Furthermore, in these therapies there is a significant association between Stage I GCI productivity and the productivity of Stages II and III GCIs. This is not the case for poor outcome cases, where results show a greater productivity of initial stage GCIs, mostly in the second half of therapy and no relation of this productivity with Stage II and Stage III GCIs. Conclusions: Results support the relation of ongoing change and final outcome. Possibilities for the clinical use of GCIs, specifically for monitoring ongoing therapies, are discussed.

Meeting in difference: Revisiting the therapeutic relationship based on patients′ and therapists′ experiences in several clinical contexts

Despite decades of research on the therapeutic relationship and the therapeutic alliance and their connection with therapeutic outcomes (Horvath, Del Re, Flückiger, & Symonds, 2011), only a handful of studies have examined how they are experienced by the therapy participants. The aim of the present study is to describe the therapeutic relationship from the subjective perspective of the patients and therapists involved in 3 clinical cases: (a) a 7-year-old child diagnosed with attention deficit hyperactivity disorder, (b) a 29-year old woman diagnosed with a personality disorder, and (c) a 22-year-old man diagnosed with schizophrenia. We conducted semistructured interviews with patients and therapists that were later analyzed following grounded theory coding procedures (Corbin & Strauss, 2008). The results obtained reveal that the constitutive elements of the therapeutic relationship are linked to 2 dimensions of the patient-therapist meeting experience: the technical and role-related dimension, characterized by relational asymmetry, and the affective exchange dimension, characterized by relational symmetry. The article discusses the possible association between the asymmetrical technical dimension, whose roles are defined by the organization of the helping relationship, and the notion of therapeutic alliance as commonly conceptualized and assessed; on the other hand, the experience of the bidirectional and symmetrical patient-therapist affective exchange is linked with concepts such as real relationship and intersubjectivity.

Therapeutic verbal communication in change episodes: a comparative microanalysis of linguistic basic forms / Comunicación verbal terapéutica en episodios de cambio: un microanálisis comparativo de las formas lingüísticas básicas

Abstract This study examines clients’ and therapists’ verbal communication during psychotherapy, in order to determine its relation to ongoing change and outcome. It replicates previous studies showing the specificity of verbalizations depending on the speaker (client or therapist) and the phase of therapy, adding its relation to change measured at the level of process and final outcome. 7,009 speaking turns of clients and therapists, nested in 139 change episodes, were analysed regarding the use of the five Linguistic Basic Forms included in the Therapeutic Activity Coding System (TACS) through Hierarchical Modelling. Results show that three of these Linguistic Basic Forms — Question, Assertion and Agreement — are related to ongoing change as well as to final outcome.

Working Alliance Inventory Versión Observacional: Traducción, Adaptación y Validación al Castellano

Resumen La investigacion ha demostrado la fuerte relacion entre alianza terapeutica y resultados en psicoterapia. Una buena alianza esta asociada a mejores resultados en psicoterapia. Para medir alianza se han desarrollado una serie de instrumentos para terapeutas, pacientes, y observadores. Los instrumentos observacionales son menos intrusivos, disminuyendo los posibles efectos que las mediciones tendrian en el tratamiento. Ademas, han resultado mas valido en algunas poblaciones clinicas. En Chile no se cuenta con un instrumento confiable y validado que mida alianza terapeutica desde la perspectiva de un observador. El presente articulo da cuenta de la traduccion al castellano, y la adaptacion y validacion del Work Alliance Inventory (WAI-0) en su version observacional para Chile. El (WAI-0) es un instrumento valido y confiable para medir alianza terapeutica. Palabras Clave : Alianza Terapeutica, Adaptacion, Validacion, Instrumento Observacional. Abstract Research has shown the strong association between therapeutic alliance and therapeutic outcomes. A good alliance is linked with better outcomes in psychotherapy. A number of instruments have been developed to measure the alliance aimed at therapists, patients, and observers. Observational instruments are less intrusive, and reduce the possible effects that measurements may have on treatment. In addition, they have proven to be more valid in some clinical populations. In Chile, there are no reliable and validated instruments to measure the therapeutic alliance from the point of view of an observer. The present article introduces a translation into Spanish along with an adaptation and validation for Chile of the Work Alliance Inventory (WAI-O) in its observational version. WAI-O is a valid and reliable instrument for measuring the therapeutic alliance.

Disentangling the change-alliance relationship: Observational assessment of the therapeutic alliance during change and stuck episodes.

Abstract The therapeutic alliance is considered the most robust process variable associated with positive therapeutic outcome in a variety of psychotherapeutic models [Alexander, L. B., & Luborsky, L. (1986). The Penn Helping Alliance Scales. In L. S. Greenberg & W. M. Pinsoff (Eds.), The psychotherapeutic process: A research handbook (pp. 325–356). New York: Guilford Press; Horvath, A. O., Gaston, L., & Luborsky, L. (1993). The alliance as predictor of benefits of counseling and therapy. In N. Miller, L. Luborsky, J. Barber, & J. P. Docherty (Eds.), Psychodynamic treatment research: A handbook for clinical practice (pp. 247–274). New York, NY: Basic Books; Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48, 9–16; Orlinky, D., Grawe, K., & Parks, B. (1994). Process and outcome in psychotherapy: Noch einmal. In A. Bergin & J. S. Garfield (Eds.), Handbook of psychotherapy and behaviour change (4th ed., pp. 270–378). New York, NY: Wiley and Sons]. The relationship between alliance and outcome has traditionally been studied based on measures that assess these therapy factors at a global level. However, the specific variations of the alliance process and their association with therapy segments that are relevant for change have not yet been fully examined. The present study examines the variations in the therapeutic alliance in 73 significant in-session events: 35 change and 38 stuck episodes identified through the observation of 14 short-term therapies of different theoretical orientations. Variations in the alliance were assessed using the VTAS-SF [Shelef, K., & Diamond, G. (2008). Short form of the revised Vanderbilt Therapeutic Alliance Scale: Development, reliability, and validity. Psychotherapy Research, 18, 433–443]. Nested analyses (HLM) indicate a statistically significant better quality of the alliance during change episodes.

Introduction: current developments in psychotherapy process research / Introducción: desarrollos actuales en la investigación del proceso psicoterapéutico

Abstract The questions that guide psychotherapy process research are: what changes in psychotherapy? And, how does that change occur? These questions have been present in clinical settings and psychotherapy research for decades, generating a substantial amount of knowledge for the discipline. Based on a questioning of the limitations of traditional psychotherapy research, whose primary focus has been the study of final outcomes of treatment, this area of research has exposed important conceptual and methodological proposals for the study of the process. Despite its long and productive tradition, research into the psychotherapeutic process is currently gathering a new momentum from the growing conviction of the need to focus efforts on studies that can account for the elements, mechanisms and processes associated with change. In this introduction we organize the field of psychotherapy process research, according to its units of analysis — macro- or micro-processes — and the foci on which they are based: content, factors and mechanisms of change. The different ways in which these components are organized are exemplified with the articles included in this monograph. We then give an overview of the most used methods in this field of study, also referring to the studies that report on the application of these methods in this special issue of Studies in Psychology.