Mariane Krause

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.

The transformation of social representations of chronic disease in a self-help group.

A Participant Action Research process was carried out with individuals affected by Inflammatory Bowel Disease, more specifically Crohn’s Disease and Ulcerative Colitis. The results show evidence of a transformation of social representations of disease. ‘Normalization’ is the central component of the transformation, indicating the achievement of a more restricted representation of the illness. This change is an attitudinal modification, which is characterized by higher tolerance of the disease— accepting its chronic nature and the limitations it imposes on daily life—, acceptance of the possibility of being supported by others in facing the disease, and the recognition of a transformational process that involves different stages in dealing with and accepting the disease.

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.

Representaciones Sociales de los Chilenos Acerca del 11 de Septiembre de 1973 y su Relación con la Convivencia Cotidiana y con la Identidad Chilena

El 11 de septiembre de 1973 es una fecha de profunda significacion en Chile. Su vigencia muestra que, al hablar de las representaciones sociales y los efectos actuales del 11, se esta haciendo referencia a contenidos de un momento especifico dentro de un proceso. Se abordo este trabajo desde la perspectiva teorica de las representaciones sociales, entendidas como una elaboracion colectiva, intersubjetiva, posible a traves de la comunicacion y que se constituye en una manera de interpretar y aprehender la realidad cotidiana (Jodelet, 1984; Wagner & Elejabarrieta, 1994). Los elementos valorativos, afectivos, simbolicos y cognitivos con que se mira el 11, construyen realidades intersubjetivas que influyen en el modo de relacionarse de las personas, afectando la convivencia cotidiana e interviniendo en el modo de ser y de sentirse chileno.

El pasado que nos pesa: La memoria colectiva del 11 de septiembre de 1973

This paper presents the results of a public opinion poll about the 11th of September of 1973 and the military regimen, applied to 792 persons from the Metropolitan Region of Santiago. The sample included participants of different ideological orientation and three political generations: persons who turned 18 years old before 1973, those who did it between 1974 and 1989, and finally, those who turned 18 from 1990 onwards. The results confirmed that the 11th of September of 1973 remains subjectively relevant for most people of the three generations. The analyses revealed mild generational differences. The ideological position continues to be a key factor in differentiating perceptions and memories about this historical event, although unexpected similarities among people from different political perspectives were found in some of the issues.

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.

Social Representations of Psychological Problems: Contents and Transformations

This article reports the results from a study of social representations of psychological problems.¹ Knowledge of these representations is important because of their role in understanding both the acceptance and effectiveness of psychological help. The research was conducted in a low socio-economic area of Santiago, Chile. Discrepancies have been found between the social representations of psychological problems held by professionals and those held by community members in such settings. A combination of qualitative and quantitative methods was used, gathering data from 15 individual interviews, two group interviews, and a questionnaire survey using open-ended questions on a sample of 203 individuals. Information provided by the mass media was also analyzed. The results obtained refer to social representations of psychological problems, problems requiring psychological treatment, labeling of psychological problems and sources of influence in the maintenance or transformation of these representations. Analysis of the main sources of influence and comparison between individuals with and without experience regarding psychological help lead to the conclusion that this social representation is undergoing a change, in that its contents are evolving from more pathological elements to more everyday problems.

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.