Juan Martín Gómez Penedo

Construyendo una red de investigación orientada por la práctica de jóvenes terapeutas e investigadores en países de habla hispana: Por qué, quiénes y cómo

espanolLa Red para el desarrollo de jovenes psicoterapeutas e investigadores es una Red de Investigacion Orientada por la Practica (RIOP) conformada por clinicos e investigadores jovenes, en sus primeros anos de desarrollo profesional. Siguiendo los principios de la Investigacion Orientada por la Practica, el presente trabajo tiene como objetivo describir el proceso de construccion de esta RIOP proporcionando una explicacion general de las razones que motivaron su desarrollo, asi como las caracteristicas actuales de los psicoterapeutas jovenes. Para introducir el contexto en el que se basa esta RIOP, se proporcionan datos empiricos sobre la composicion de los psicoterapeutas en Argentina y Espana. Se presentan dos estudios: el primero describe el desarrollo de un cuestionario que explora las actitudes de los psicoterapeutas y el uso de los resultados de la investigacion en la practica clinica, las dificultades que encuentran para acceder a los resultados cientificos y para llevar a cabo una investigacion. Ademas, se estudiaron las propiedades psicometricas del cuestionario, obteniendose una solucion de tres factores. Tambien se observo que los clinicos espanoles informan mayores dificultades de acceso a la investigacion que los argentinos. El segundo estudio explora como los terapeutas toman decisiones clinicas y estas impactan en el proceso de tratamiento y su resultado. Ademas, se observaron diferentes procesos de toma de decision clinica al comparar un clinico puro (mas orientado a la experiencia profesional y a los resultados de la investigacion) con un clinico que realiza tambien tareas de investigacion (mas propenso a guiarse por la intuicion y la supervision). La alianza terapeutica y el curso clinico de los pacientes se asociaron con estos procesos de toma de decisiones. Se describen las implicaciones clinicas de los resultados y se presentan los planes futuros de la RIOP. EnglishRed para el desarrollo de jovenes psicoterapeutas e investigadores (Network for the Development of Young Psychotherapists and Researchers) is a Practice Research Network (PRN) conformed by early career clinicians and researchers. Following Practice-Oriented Research principles, the present study aims to describe the building process of this PRN by providing an overall explanation of the reasons that motivate its development, as well as to characterize the current situation of early career psychotherapists. To introduce the context in which our PRN is built, empirical data on the composition of early career psychotherapists in Argentina and Spain will be provided. Two studies are presented. The first study describes the development of a questionnaire that explores psychotherapists’ attitudes and use of research outcomes in the clinical practice, as well as difficulties in accessing to scientific results and barriers to conducting research. The second study explores how therapists make clinical decisions and how these decisions impact on treatment process and outcome. In study 1, the psychometric properties of the questionnaire were explored and a three-factor solution was obtained. We also observed that Spanish clinicians reported greater research accessibility difficulties than Argentines. Study 2 revealed different clinical decision-making processes when comparing pure clinicians (more oriented towards professional experience and research outcomes) and research clinicians (more likely to be guided by intuition and supervision). The therapeutic alliance and the clinical course of patients were associated with these decision-making processes. Clinical implications of the results are described and future plans of the PRN are presented.

EVALUACIÓN DE UN DISPOSITIVO DE INVESTIGACIÓN ORIENTADA POR LA PRÁCTICA PARA EL DESARROLLO DE UN SISTEMA DE FEEDBACK EN PSICOTERAPIA

espanolEl objetivo del presente trabajo es exponer y evaluar las experiencias involucradas en el desarrollo de un dispositivo de Investigacion Orientada por la practica, con el fin de crear un recurso que sirva tanto para la clinica como para la investigacion. Un equipo interdisciplinario conformado por directivos de una clinica, terapeutas e investigadores diseno en conjunto un dispositivo de monitoreo de resultados y feedback para terapeutas, que permite recabar datos periodicos del estado de los pacientes y brindar informacion a los terapeutas sobre su evolucion. El Sistema de Evaluacion de Tratamientos (SET) esta conformado por cinco preguntas orientadas a evaluar procesos de evolucion general del paciente. El SET cuenta con sistemas de alertas que adviertan al terapeuta, mediante un procedimiento sencillo, respecto de situaciones que podrian ser importantes para repensar el tratamiento de los pacientes. Este sistema de alarmas incluye: Alertas para supervisar, alerta para implementar maniobras de cierre y alerta para dar el alta a los pacientes. En este articulo se evalua el proceso de trabajo interactivo entre clinicos e investigadores y su resultado, en terminos de las fortalezas y debilidades del dispositivo clinico desarrollado, tanto para captacion de datos, con fines clinicos y de investigacion, asi como tambien en aspectos relacionados con la sustentabilidad en el tiempo de dicho dispositivo. Finalmente, se discute el valor de un trabajo integral entre estos actores y se plantean obstaculos observados a lo largo del proceso y soluciones tentativas para los mismos. EnglishThe aim of the current study is to expose and evaluate the experiences involved in the development of a Practice Oriented Research device in order to create a resource helpful for both: clinicians and researchers. An interdisciplinary team of managers of a clinic, therapists and researchers designed together a device for monitoring results and feedback for therapists which allows collecting periodic data of the patients status and providing information about their evolution. The Treatment Evaluation System (SET) consists of five questions aimed at evaluating the general evolution of the patient. The SET has an alert system which warns the therapist, through a simple procedure, regarding situations that could be important to reconsider about the treatment of each patient. This alarm system includes: Alerts to monitor, alert for implementing closing interventions and alert to discharge patients. This article evaluates the interactive work process between clinicians and researchers and its results, in terms of the strengths and weaknesses of the clinical device developed for data collection, for clinical and research purposes, as well as aspects related to the sustainability over time of said device. Finally, we discussed the important of an integral work between these actors and obstacles observed throughout the process and tentative solutions for them are raised.

Patient baseline interpersonal problems as moderators of outcome in two psychotherapies for bulimia nervosa

Abstract Objective: We tested an aptitude by treatment interaction; namely, whether patients’ baseline interpersonal problems moderated the comparative efficacy of cognitive-behavioral therapy (CBT) vs. interpersonal psychotherapy (IPT) for bulimia nervosa (BN). Method: Data derived from a randomized-controlled trial. Patients reported on their interpersonal problems at baseline; purge frequency at baseline, midtreatment, and posttreatment; and global eating disorder severity at baseline and posttreatment. We estimated the rate of change in purge frequency across therapy, and the likelihood of attaining clinically meaningful improvement (recovery) in global eating disorder severity by posttreatment. We then tested the interpersonal problem by treatment interactions as predictors of both outcomes. Results: Patients with more baseline overly communal/friendly problems showed steeper reduction in likelihood of purging when treated with CBT vs. IPT. Patients with more problems of being under communal/cold had similar reductions in likelihood of purging across both treatments. Patients with more baseline problems of being overly agentic were more likely to recover when treated with IPT vs. CBT, whereas patients with more problems of being under agentic were more likely to recover when treated with CBT vs. IPT. Conclusions: Interpersonal problems related to communion and agency may inform treatment fit among two empirically supported therapies for BN.

A time-series analysis of therapeutic alliance, interventions, and client’s clinical status in an evidence-based single-case study: Evidence for establishing change mechanisms in psychotherapy

Abstract Objective: The goal of this study was to analyze the time-series of alliance, interventions, and client’s post-sessions clinical status, to establish if alliance and adherence to cognitive-behavioral interventions preceded improvement in psychotherapy Method: A single-case study of a complete Cognitive-Behavioral treatment of a 27-year-old male diagnosed with Generalized Anxiety Disorder treatment was conducted. Alliance, adherence to cognitive-behavioral interventions, and client’s therapeutic condition were assessed every two sessions during the entire treatment. Results: After controlling for the effect of autocorrelations, the transfer functions showed that alliance predicted client’s clinical condition with a lag of two sessions throughout the entire treatment. However, the inverse relationship was not observed. Conclusions: Results support the hypothesis of a time-lagged association between alliance and subsequent client’s changes in their clinical condition in single case of a cognitive-behavioral treatment.

Relation of patient and therapist interpersonal impact messages to outcome in interpersonal therapy for depression.

Interpersonal depression theories posit that excessive submissiveness in social interactions perpetuates negative mood. Correspondingly, many psychotherapies postulate that improvement can be facilitated by patient−therapist interactions. However, few studies have tested in-session patient and therapist behaviors that should, in theory, associate with depression reduction. Addressing this gap, the present study examined such associations in interpersonal psychotherapy (IPT). We hypothesized that decreases in patients’ submissive interpersonal impacts on their therapist would be associated with greater depression reduction, as would increases in therapists’ friendly submissive impacts on their patient; theoretically, such therapist behavior would pull for patients to complement it with adaptive assertiveness, thereby disrupting their submissive tendencies. Data derived from an open trial of 16 IPT sessions for adults with major depression. Patients (N = 119) and therapists (N = 39) rated the others’ interpersonal impacts at Sessions 3 and 16 via the Impact Message Inventory. Patients rated their depression on the Beck Depression Inventory—Second Edition after each session. As predicted, multilevel modeling revealed that decreases in patients’ submissive impacts were associated with greater concurrent depression reduction (p = .03) and lower posttreatment depression level (p = .03). Also, although therapists did not differ in their change in friendly submissive impacts, thus precluding a test of the influence of such change on outcome, a greater average level of therapist friendly submissiveness related to lower posttreatment depression (p = .008). Results support interpersonal depression theories and the therapeutic benefit of specific patient and therapist change processes in IPT. Relación de los mensajes de impacto interpersonal de pacientes y terapeutas con los resultados en la terapia interpersonal para la depresión Las teorías de depresión interpersonal postulan que la sumisión excesiva en las interacciones sociales perpetúa el estado de ánimo negativo. En consecuencia, muchas psicoterapias postulan que la mejora puede ser facilitada por las interacciones del terapeuta del paciente. Sin embargo, pocos estudios han probado comportamientos de paciente y terapeuta durante la sesión que, en teoría, deberían asociarse con la reducción de la depresión. Al abordar esta brecha, el presente estudio examinó tales asociaciones en la psicoterapia interpersonal (IPT). Presumimos que las disminuciones en los impactos interpersonales sumisos de los pacientes en su terapeuta se asociarían con una mayor reducción de la depresión, al igual que los aumentos en el impacto sumiso amistoso de los terapeutas en sus pacientes; teóricamente, tal comportamiento terapeuta haría que los pacientes lo complementaran con asertividad adaptativa, lo que interrumpiría sus tendencias sumisas. Datos derivados de una prueba abierta de 16 sesiones de IPT para adultos con depresión mayor. Los pacientes (N = 119) y los terapeutas (N = 39) evaluaron los impactos interpersonales de los demás en las Sesiones 3 y 16 a través del Inventario de mensajes de impacto. Los pacientes clasificaron su depresión en el Inventario de Depresión de Beck-Segunda Edición después de cada sesión. Como se predijo, la modelización multinivel reveló que las disminuciones en los impactos sumisos de los pacientes se asociaron con una mayor reducción concurrente de la depresión (p < 0.03) y un menor nivel de depresión post-tratamiento (p < 0.03). Además, aunque los terapeutas no difieren en su cambio en los impactos de sumisión amistosa, lo que impide una prueba de la influencia de tales cambio en el resultado, un mayor nivel promedio de sumisión amistosa del terapeuta relacionado con una depresión postratamiento más baja (p. 008). Los resultados respaldan las teorías de depresión interpersonal y el beneficio terapéutico de los procesos de cambio específicos de pacientes y terapeutas en IPT.

Client–therapist agreement in the termination process and its association with therapeutic relationship.

There is no consensus among different therapeutic approaches on the process of termination when therapy does not have a prefixed duration. Moreover, both clinicians and researchers are still exploring decision making in the termination of treatment. The present study assessed former client’s perspective of therapy termination in a nonprobabilistic sample from Buenos Aires, Argentina. Seventy-three semistructured interviews, lasting ∼60 min each, were conducted with participants that had finished a therapeutic treatment or dropped out. They were asked about several aspects of therapy, including their experience of termination, specifically who decided to terminate, if there was agreement on termination or not, and their thoughts on the termination process. All interviews were transcribed and analyzed using an adaptation of Consensual Qualitative Research (CQR). Quantitative analyses were also conducted to examine associations between variables. Two main factors emerged from the analysis: client/therapist initiative on termination; and level of agreement between client and therapist regarding termination. Whereas nearly all (95%) of therapist-initiated termination cases agreed on termination, client-initiated termination cases could be sorted in agreed (49%) and disagreed (51%) terminations. Both therapist-initiated terminations and agreed upon terminations presented more categories of positive termination motives, better therapeutic bond, and higher overall satisfaction with treatment. Implications for research and clinical practice are discussed.