Guillermo de la Parra

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.

Proceso de Cambio Psicoterapéutico: Análisis de Episodios Relevantes en una Terapia Grupal con Pacientes Adictos

En el presente articulo se presentan los resultados de una investigacion que tuvo como objetivo determinar y describir el tipo de acciones comunicacionales realizadas por terapeutas y pacientes durante las sesiones de una terapia grupal. Para esto se utilizo una metodologia orientada al descubrimiento empleando un analisis cualitativo de contenido. En los resultados se incluye tanto la descripcion de las acciones identificadas de acuerdo al nivel de analisis, asi como los patrones ideales de secuencia de dichos componentes asociados al cambio y propios de esta modalidad terapeutica. Finalmente, los resultados son discutidos considerando los principales antecedentes teoricos y empiricos en materia de investigacion en psicoterapia.

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.

Psychotherapy research in developing countries: The case of Latin America

Abstract This article describes the state of psychotherapy research in Latin America, a developing region, by means of its scientific production as reflected in international and Latin American publications, as well as through a survey and in-depth interviews with clinicians and researchers from the region. The Latin American publication rate is still low in international journals, which stands in contrast with the high level of publication within the region. The survey reveals an interest in research as well as a limited use of research in clinical practice, while exposing the difficulties of researching and publishing. The in-depth interviews, which cover most of the region, specify Latin Americas shortcomings and obstacles to researching, as well as its facilitating factors and comparative advantages. The results are discussed within the framework of the colonizer-colonized relationship, Latin American identity, and the creative integration of developed and developing regions.This article describes the state of psychotherapy research in Latin America, a developing region, by means of its scientific production as reflected in international and Latin American publications, as well as through a survey and in-depth interviews with clinicians and researchers from the region. The Latin American publication rate is still low in international journals, which stands in contrast with the high level of publication within the region. The survey reveals an interest in research as well as a limited use of research in clinical practice, while exposing the difficulties of researching and publishing. The in-depth interviews, which cover most of the region, specify Latin Americas shortcomings and obstacles to researching, as well as its facilitating factors and comparative advantages. The results are discussed within the framework of the colonizer-colonized relationship, Latin American identity, and the creative integration of developed and developing regions.

Del "diván" al policlínico: un modelo de psicoterapia para instituciones. Aprendiendo de la experiencia (empírica)

espanolLa Unidad de Psicoterapia de Adultos (UPA) se formo hace 15 anos en el contexto de la Unidad de Salud Mental, un centro universitario que ofrece servicios psiquiatricos y psicoterapeuticos. El presente articulo tiene dos objetivos: (1) dar cuenta de la implementacion de un modelo de atencion que se sustenta en el modelo de factores comunes, indicacion adaptativa (responsiveness) y practica basada en la evidencia; (2) presentar resultados respecto al efecto de la implementacion de este modelo en la practica rutinaria. Se discuten los resultados en cuanto a sus consecuencias clinicas, de formacion e investigacion. EnglishThe Adult Psychotherapy Unit (UPA) was formed 15 years ago in the context of the Mental Health Unit, an university center that offers psychiatric and psychotherapeutic services. The present article has two objectives: (1) to account for the implementation of a care model that is based on the model of common factors, adaptive indication (responsiveness) and evidence based practice; (2) to present results regarding the effect of the implementation of this model in the routine practice. The results are discussed in terms of their clinical, training and research consequences.

Depressive Experience Dimensions and Structural Performance: What’s at the Basis of Depression Heterogeneity?

Depression has a high prevalence worldwide and has a difficult approach because it is a heterogeneous syndrome. This study explored the associations between self-criticism and dependency dimensions of depressive experience and structural functions in 43 Chilean patients with depressive symptomatology. Patients showed either self-criticism or dependency style. Results showed that the highest the symptomatology, the worst structural functioning. Self-criticism showed to relate more with low structural functioning and self-regulation vulnerability predicted the presence of depressive symptomatology, showing a greater effect on high levels of self-criticism. The results support the perspective of considering heterogeneity at the base of depression and the importance of designing different therapeutic strategies.

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.

Role of Personality Functioning in the Quality of Life of Patients with Depression

Abstract Depression is associated with reduced quality of life (QoL), and personality pathology is associated with higher impairment and poorer treatment outcomes in patients with depression. This study aims to analyze the effects of personality functioning on the QoL of patients with depression. Severity of depressive symptoms (Beck Depression Inventory), level of personality functioning (Operationalized Psychodynamic Diagnosis Structure Questionnaire), and QoL (Medical Outcome Study 36-item Short-Form) were assessed in a sample of 84 depressive outpatients. Personality functioning showed main effects on both the mental and physical components of QoL. A moderating effect of personality functioning on the relationship between depressive symptoms and QoL was tested but not confirmed. Severity of depressive symptoms was found to mediate the effect of personality functioning on the mental component of QoL. These results suggest that the effect of personality functioning on the QoL of patients with depression may be related to the higher severity of depressive symptoms found in patients with lower levels of personality functioning.