Supervisión en una Unidad de Clínica de Adultos de un Centro de Salud Mental Universitario: Un Estudio Cualitativo del Proceso

Introducción: Las supervisiones clínicas cumplen un rol esencial dentro de la formación profesional del psicólogo clínico. Se han desarrollado diferentes modelos de supervisión, sin embargo, pocos estudios abordan el cómo se desarrolla el proceso de supervisión propiamente tal. Objetivo: Describir las dinámicas de supervisión clínica grupal en la Unidad de Adultos del Servicio de Psicología Integral de una Clínica Universitaria, que proporciona atención psicológica a la comunidad. Metodología: Estudio cualitativo descriptivo y de alcance transversal, en una muestra de 5 sesiones de supervisión videograbadas, cuya interacción verbal fue sometida a análisis de contenido convencional. Resultados: Se distinguen aspectos de la apertura del proceso de supervisión, en el cual se identifica una dificultad variable de los supervisados para formular preguntas de supervisión, dificultad enmarcada en un contexto de involucramiento afectivo de los supervisados. Se identifican intervenciones de los miembros del equipo de supervisión: una transversal de validación de la experiencia del supervisado; e intervenciones durante el proceso de supervisión, como, por ejemplo, preguntas dirigidas a revisar "la experiencia" del supervisado durante la atención del caso; "construcción de hipótesis comprensivas del caso", y la entrega de "sugerencias para el abordaje terapéutico" del caso en específico, y/o que pueden ser aplicados a otros casos.

Background: Clinical supervision plays an essential role in the professional training of clinical psychologists. Different supervision models have been developed; however, few studies address how the ongoing process of supervision is developed. Objective: To describe the dynamics of clinical group supervision at the Adult Unit of the Clinical Psychology Service of a University Clinic, which provides psychological care to the community. Methodology: A descriptive qualitative study of cross-sectional scope, in a sample of 5 video-recorded supervision sessions, whose verbal interaction was subjected to conventional content analysis. Results: Aspects of the opening of the supervision process are distinguished, in which a different degree of difficulties of the supervisees to formulate supervision questions is identified, a difficulty framed in a context of affective involvement of the supervisees. Interventions by members of the supervision team are identified: a validation of the supervisee's experience which is present each one supervision process; and specific interventions during the supervision process, for example, questions aimed at reviewing «the experience» of the supervisee during the care of the case; «construction of comprehensive hypotheses of the case», and the delivery of «suggestions for the therapeutic approach» of the specific case, and/or that can be applied to other ones.

Factores Asociados al Autoestigma de la Depresión en Adolescentes en Santiago, Chile / Associated factors with self-stigma of depression in adolescents in Santiago, Chile

Determinar la asociación entre autoestigma de la depresión y factores sociodemográficos, historia personal y parental de depresión, sintomatología ansiosa y depresiva, y calidad de vida en adolescentes. Método: Estudio transversal correlacional, en una muestra de 192 adolescentes (8º básico a 3º medio) de tres colegios particulares subvencionados de Santiago, Chile, se aplicaron cuestionarios de factores sociodemográficos, autoestigma de la depresión, sintomatología ansiosa y depresiva, y calidad de vida. Los datos se analizaron con prueba t de Student, ANOVA, coeficiente de Pearson y Regresión Lineal. Resultados: No hubo diferencias en autoestigma de depresión entre hombres y mujeres. Fue mayor el autoestigma de la depresión en adolescentes que sospechaban que habían tenido o tenían depresión, referían que su madre o padre habían tenido depresión, tenían mayor sintomatología depresiva y/o ansiosa y menor calidad de vida. Conclusión: La presencia de depresión en los progenitores progenitores (madre y/o padre), así como el desconocimiento de los adolescentes respecto a si ellos presentan el cuadro clínico, se relaciona con mayor autoestigma de la depresión en los adolescentes, lo que inhibe la búsqueda de ayuda.

To determine the association between self-stigma of depression and sociodemographic factors, personal and parental history of depression, anxious and depressive symptomatology, and quality of life in adolescents. Methods: Non-experimental cross-sectional and correlational study. A total of 192 adolescents from 8th grade to 11th grade from three private subsidized schools in Santiago, Chile, answered questionnaires on sociodemographic factors, self-stigma of depression, anxious and depressive symptomatology, and quality of life. Data were analyzed with Student's t-test, ANOVA, Pearson's coefficient and linear regression. Results: There were no differences in self-stigma of depression between men and women. Self-stigma of depression was higher in adolescents who suspected that they had had or had depression, who reported that their mother or father had had depression, who had greater depressive and/or anxious symptomatology and lower quality of life. Conclusion: The presence of depression in the parents (mother and / or father) as well as the lack of knowledge of adolescents regarding whether they have depression is related to greater self-stigma of depression which inhibits the help-seeking in adolescents.

Propiedades psicométricas del inventario de depresión de Beck IA para la población chilena / Psychometric properties of a spanish version of the Beck depression inventory IA

Background: According to the Chilean National Health Survey (2009-2010), 17% of people aged 15 years or more have depressive symptoms. Thus, freely-available, easily-administered, and highly sensitive screening tests for depression are needed in clinical and research settings. Aim: To evaluate the psychometric properties of a Spanish version of the Beck Depression Inventory (BDI-IA) in adult Chilean population. Material and Methods: The inventory was applied to a sample of 1.105 adults aged between 18 to 73 years (94% women). Ninety nine participants were outpatients receiving treatment for affective disorders, 932 were parents and/or guardians of students enrolled in schools and 73 were university students (sample with no known depressive disorder). To perform data analysis, two groups from the random combination of both samples were generated. Results: The inventory showed an appropriate degree of internal consistency (Cronbach alpha = .92). An exploratory factor analysis suggested a one-factor solution. This solution was reinforced with a confirmatory factor analysis, which displayed an adequate goodness of fit. The cutoff score, based on the Youden Index, was 13/14 points. It was able to discriminate between depressed and non-depressed participants. Conclusions: These results indicate that the BDI-IA is an appropriate instrument to assess depressive symptoms in Chilean adults.

Vocalization-Silence Dynamic Patterns: A system for measuring coordination in psychotherapeutic dyadic conversations / Patrones Dinámicos de Vocalización-Silencio: un sistema para medir coordinación en conversaciones diádicas en psicoterapia

Abstract This paper presents the Vocalization-Silence Dynamic Patterns (VSDP) method for the analysis of coordination in psychotherapeutic conversation. The objectives of its development are to empirically account for vocal coordination patterns in dialogs and to examine the association between interactional coordination and positive relational outcomes. The VSDP method makes it possible to demonstrate that vocal activity is a nonverbal phenomenon entwined with and which influences the linguistic code. The analyses which can be carried out through this method are illustrated with real acoustic signals taken from psychotherapy segments. The VSDP method is discussed, considering its usefulness for psychotherapeutic research as well as the study of dyadic conversation within other scenarios.

Resumen Este trabajo presenta el método de Patrones Dinámicos de Vocalización-Silencio (PDVS) para el análisis de la coordinación en la conversación psicoterapéutica. Los objetivos de su desarrollo son dar cuenta empíricamente de los patrones de coordinación vocales en diálogos y examinar la asociación entre la coordinación interaccional y los resultados relacionales positivos. El método PDVS hace posible demostrar que la actividad vocal es un fenómeno no verbal entrelazado con y que influye en el código lingüístico. Los análisis que se pueden realizar a través de este método se ilustran con señales acústicas reales tomadas de segmentos de psicoterapia. El método PDVS es discutido teniendo en cuenta su utilidad para la investigación en psicoterapia, así como para el estudio de la conversación diádica dentro de otros escenarios.

Validación de la Escala Rapid Assessment of Physical Activity (RAPA) en población chilena adulta consultante en Atención Primaria / Validation of the Rapid Assessment of Physical Activity Scale (RAPA) in an Adult Chilean Population Seeking Primary Care / Validação da escala Rapid Assessment of Physical Activity (Rapa) em população chilena idosa consultante em Atenção Primária

Introducción: la práctica de actividad física es esencial para el cuidado de la salud. Se requiere contar con instrumentos que permitan medirla y monitorear los cambios en las personas que la practican. Objetivos: adaptar culturalmente el cuestionario Rapid Assessment of Physical Activity (RAPA), y estimar sus propiedades psicométricas, su validez y confiabilidad, para medir el nivel de actividad física en personas adultas consultantes en centros de atención primaria en Santiago (Chile). Materiales y métodos: el RAPA adaptado fue aplicado a 180 adultos asistentes a 5 centros de salud. Se determinó su índice de masa corporal (IMC) y circunferencia de cintura (CC). Resultados: las puntuaciones en la escala RAPA se relacionaron en forma inversa y significativa con el perímetro de cintura y el IMC. Las personas categorizadas con bajo nivel de actividad física (Poco Activo y Poco Activo Regular Ligero) presentan un IMC promedio más elevado y son más frecuentemente categorizados con CC alterada. La confiabilidad del instrumento fue moderada (r = 0,61; K = 0,34). Conclusiones: el RAPA en su versión en español adaptada para Chile, es un instrumento de fácil aplicación, que pese a su moderada confiabilidad, logra ser sensible al desarrollo de actividad física, que presenta una relación coherente con los parámetros antropométricos de IMC y CC sensibles a dicha actividad.

Introduction: Physical activity is vital to health care and having instruments to measure and monitor changes in people who are physically active is essential. Objectives: Culturally adapt the Rapid Assessment of Physical Activity (RAPA) questionnaire and estimate its psychometric properties, validity and reliability as an instrument to measure the level of physical activity among adults seeking primary care at health centers in Santiago (Chile). Materials and Methods: The adapted RAPA was applied to 180 adults who were being treated at five health centers. Their body mass index (BMI) and waist circumference (WC) was determined. Results: The scores on the RAPA scale were inversely and significantly linked to waist circumference and BMI. Persons categorized as having low levels of physical activity (i.e., little activity and little regular light activity) have a higher BMI, on average, and are more often categorized with altered WC. The reliability of the instrument was moderate (r = 61; K = 0.34). Conclusions: The Spanish language version of the Rapid Assessment of Physical Activity (RAPA) questionnaire adapted for Chile is a user-friendly application. Despite being only moderately reliable, it is sensitive to the development of physical activity, which shows a coherent connection to the anthropometric parameters of BMI and WC that are sensitive to this kind of activity.

Introdução: a prática de atividade física é essencial para o cuidado da saúde. Requer-se contar com instrumentos que permitam medi-la e monitorar as mudanças nas pessoas que a praticam. Objetivos: adaptar culturalmente o questionário Rapid Assessment of Physical Activity (Rapa) e estimar suas propriedades psicométricas, sua validade e confiabilidade para medir o nível de atividade física em pessoas idosas consultantes em centros de atenção primária em Santiago (Chile). Materiais e método: o Rapa adaptado foi aplicado a 180 idosos frequentadores de cinco unidades de saúde. Determinou-se seu índice de massa corporal (IMC) e circunferência de cintura (CC). Resultados: as pontuações na escala Rapa se relacionaram em forma inversa e significativa com o perímetro de cintura e o IMC. As pessoas categorizadas com baixo nível de atividade física (pouco ativo e pouco ativo regular leve) apresentaram um IMC médio mais elevado e são mais frequentemente categorizadas com CC alterada. A confiabilidade do instrumento foi moderada (r = ,61; K = 0,34). Conclusões: o Rapa em sua versão em espanhol adaptada para o Chile é um instrumento de fácil aplicação, que, mesmo com sua moderada confiabilidade, consegue ser sensível ao desenvolvimento da atividade física, que apresenta uma relação coerente com os parâmetros antropométricos de IMC e CC sensíveis a essa atividade.

Caracterización de cyberbullying en el gran Santiago de Chile, en el año 2010 / Cyberbullying prevalence in Santiago of Chile, in 2010

El estudio caracteriza el cyberbullying en estudiantes del gran Santiago de Chile (2010). Se aplicó una encuesta de autorreporte (Cuestionario de Experiencias de Internet) a 1.357 estudiantes entre 7º básico a IVº medio. El diseño de muestra fue no probabilístico por cuotas en 32 establecimientos educacionales, ponderados según género, curso y tipo de dependencia. El 50% fueron hombres, con un promedio de edad 15 años (DS= 1,82 años). Resultados: El 11,4% reportó haber sido víctima de algún tipo de cyberbullyingy el 12,5% victimario. No se encontraron diferencias significativas en las víctimas según sexo, curso y tipo de dependencia. Sólo los hombres reportan identificarse en forma más frecuente con los victimarios que las mujeres. Conclusiones: El cyberbullying es un fenómeno existente en la realidad chilena, siendo - mayormente - homogéneo en su presentación. Dado esto, se plantean nuevos desafíos y preguntas respecto a sus consecuencias tanto para los estudiantes como para todo el sistema escolar.

This study characterizes the cyberbullying among students in Santiago, Chile (2010). A self-report questionnaire (Internet Experiences Questionnaire) was completed by 1,357 students from 7th to 12th grade. The sample design was non-probability and based on quota sampling. The data were weighted by gender, grade and type of school dependency. Among the respondents 50% were men, average age 15 years (SD = 1.82 years). The results show that 11.4% reported having been the victim of some form of cyberbullying and 12.5% victimizer. No significant differences were found between the gender, grade or type of school dependency of the victims. In the role of perpetrator, boys reported a higher frequency in compare to girls. We conclude that cyberbullying is a phenomenon that exists in Chilean reality, and it is mostly-homogenous in its presentation. Given this, new challenges and questions regarding the consequences of cyberbullying for students and the educational system are raised.

Validación inicial de un instrumento de análisis del apoyo a la toma de decisiones para el manejo de enfermedades crónicas / Initial Validation of an Analytical Tool to Support Decision-making on Chronic Illness Management / Validação inicial de um instrumento de análise do apoio na tomada de decisões para o manejo de doenças crônicas

Introducción: el apoyo a la toma de decisiones en salud facilita el automanejo de personas con enfermedades crónicas (EC). Objetivo: validar la versión en español del DSAT-cdm: herramienta de análisis del apoyo en las decisiones para el manejo de EC, desarrollada por Stacey (2006). Materiales y métodos: estudio descriptivo que aplica un proceso sistemático que considera, entre otros: traducción-contratraducción, desarrollo de escenarios de simulación, entrenamiento de evaluadores, entrenamiento pacientes simulados y capacitación para participantes. Muestra: 15 profesionales y 2 jueces, obteniéndose 60 DSAT-cdm versión español aplicado (pre y pos capacitación). Resultados: el instrumento presentó confiabilidad aceptable en la aplicación entre-jueces y detectó la mejora en la calidad del apoyo a la toma de decisiones en los profesionales. Sin embargo, no se obtuvieron resultados que aportaran a la validez de criterio concurrente. Conclusiones: este estudio es la primera evaluación del DSAT-cdm en idioma español, el resultado principal indica que se detecta un cambio en el desempeño de profesionales para apoyar el proceso de toma de decisiones de sus pacientes y, a pesar estos hallazgos favorables, es necesario seguir evaluando el instrumento.

Introduction: Support for decision-making in health facilitates self-management by persons with chronic illness (CI). Objective: Validate the Spanish- language version of DSAT - cdm: an analytical tool developed by Stacey (2006) to support decision-making on CI management. Materials and Methods: This descriptive study applies a systematic process that considers a number of aspects, such as translation - back-translation, simulation scenario development, training evaluators, simulated patient training and training for participants. Sample: 15 professionals and two judges, obtaining 60 DSAT - cdm with the applied Spanish version (pre and post training). Results: The instrument showed acceptable reliability in application among judges and found improvement in the quality of decision-making support on the part of professionals. However, no results were obtained that contribute to concurrent criterion validity. Conclusions: This study is the first assessment of DSAT - cdm in Spanish. The main result indicates a change is detected in the performance of professionals to support the decision-making process of their patients. Yet, despite this favorable finding, further evaluation of the instrument is necessary.

Introdução: o apoio na tomada de decisões em saúde facilita o automanejo de pessoas com doenças crônicas (ec em espanhol). Objjetivo: validar a versão em espanhol do DSTA-cdm: ferramenta de análise do apoio nas decisões para o manejo de ec, desenvolvida por Stacey (2006). Materiais e métodos: estudo descritivo que aplica um processo sistemático que considera, entre outros: tradução-contratradução, desenvolvimento de cenários de simulação, treinamento de avaliadores, treinamento de pacientes simulados e capacitação para participantes. Amostra: 15 profissionais e 2 juízes, com obtenção de 60 dsat-cdm versão espanhol aplicado (pré e pós capacitação). Resultados: o instrumento apresentou confiabilidade aceitável na aplicação entre juízes e detectou a melhoria na qualidade do apoio na tomada de decisões nos profissionais. Contudo, não se obtiveram resultados que contribuíssem para a validade de critério concorrente. Conclusões: este estudo é a primeira avaliação do dsat-cdm em espanhol; o resultado principal indica que se detecta uma mudança no desempenho de profissionais para apoiar o processo de tomada de decisões de seus pacientes e, apesar dessas descobertas favoráveis, é necessário continuar avaliando o instrumento.

Evaluación de la efectividad del Programa Vínculos para la prevención e intervención del Bullying en Santiago de Chile / Assessment of the efectiveness of an intervention called "Vínculos" to prevent Bullying in Santiago de Chile / Avaliação da eficácia do Programa Vínculos para prevenção e intervenção sobre o Bullying em Santiago do Chile

El Bullying, por sus características y consecuencias, se ha transformado en una preocupación central en los colegios, los cuales han desarrollado diferentes formas de afrontarlo. El objetivo principal de este artículo es evaluar la efectividad de un programa de prevención e intervención de Bullying y Ciberbullying, en una muestra de 320 alumnas en un colegio de Santiago de Chile, a través de un diseño pre-post. El programa utilizó estrategias preventivas e integrales orientadas a realizar intervenciones en los distintos niveles del sistema escolar: colegio, sala de clases, individuo y familia. Los resultados demostraron que el programa es efectivo en disminuir el reporte de ser testigos de Bullying y la victimización de manotaje a través de internet. La efectividad del programa se debería a que se respetaron los lineamientos de los programas que han demostrado ser efectivos.

Bullying, by its nature and consequences, has become a central concern in schools, which have developed different ways of facing it. The main objective of this paper is to assess the effectiveness of a prevention and intervention program of bullying and cyberbullying in a sample of 320 students in a school for girls in Santiago de Chile, through a pre-post design. The program used preventive and comprehensive strategies aimed to perform interventions at the different levels in the school system: school, classroom, individual and family. Results showed that the program is effective in diminishing the report of witnessing bullying and victimization from bullying via Internet. The effectiveness of the program could be due to the multi-level targets of the program that taps different aspects, actors and domain of this pervasive problem.

O Bullying, por suas características e conseqüências, tornou-se uma preocupação central nas escolas, e estas desenvolveram diferentes formas de enfrentamento. O principal objetivo deste trabalho é avaliar a eficácia de um programa de prevenção e de intervenção sobre o bullying e cyberbullying em uma amostra de 320 alunas de uma escola em Santiago do Chile. A proposta de avaliação realizou-se através de aplicação de instrumentos antes e depois à implementação do programa. O programa utilizou estratégias preventivas e abrangentes destinadas a realizar intervenções em vários níveis do sistema escolar: escola, sala de aula, indivíduos e familias. Os resultados mostraram que o programa é eficaz na redução de relatos de testemunhar bullying e vitimização através da internet. A eficácia do programa dever-se-ia ao respeito das diretrizes dos programas que têm se mostrado eficazes.

"Working Alliance Inventory" versión observacional: traducción, adaptación y validación al castellano / Working Alliance Inventory observational form: translation, adaptation and validation to Spanish

La investigación ha demostrado la fuerte relación entre alianza terapéutica y resultados en psicoterapia. Una buena alianza está 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 tendrían en el tratamiento. Además, han resultado más válido en algunas poblaciones clínicas. En Chile no se cuenta con un instrumento confiable y validado que mida alianza terapéutica desde la perspectiva de un observador. El presente artículo da cuenta de la traducción al castellano, y la adaptación y validación del WorkAlliance Inventory (WAI-0) en su versión observacional para Chile. El (WAI-0) es un instrumento válido y confiable para medir alianza terapéutica.

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.

Efecto de un modelo de apoyo telefónico en el auto-manejo y control metabólico de la Diabetes tipo 2, en un Centro de Atención Primaria, Santiago, Chile / Effect of a tele-care model on self-management and metabolic control among patients with type 2 diabetes in primary care centers in Santiago, Chile

Background: Telephone based self-management support may improve the metabolic control of patients with type 2 (DM2) diabetes if it is coordinated with primary care centers, if telephone protocols and clinical guidelines are used and if it is provided by nurses trained in motivational interviewing. Aim: To assess the efficacy ofi a tele-care self-management support model (ATAS) on metabolic control of patients with DM2 attending primary care centers in a low income area in Santiago, Chile. Material and Methods: Two primary care centers were randomly assigned to continue with usual care (control group, CG) or to receive additionally 6 telecare self-management support interventions (IG) during a 15 month period. Glycosylated hemoglobin (HbA1c) was used to measure metabolic control of DM2; the “Summary of Diabetes Self-care Activities Measure” and the “Spanish Diabetes Self-efficacy” scale were used to measure self-management and self efficacy, respectively. Changes in the use of health services were also evaluated. Results: The IG maintained its HbA1c level (baseline and final levels of 8.3 ± 2.3 percent and 8.5 ± 2.2 percent respectively) whereas it deteriorated in the CG (baseline and final levels of 7.4 ± 2.3 and 8.8 ± 2.3 percent respectively, p < 0.001). The perception of self-efficacy in the IG improved while remaining unchanged in the CG (p < 0.001). Adherence to medication, physical activity and foot care did not change in either group. In the IG, compliance to clinic visits increased while emergency care visits decreased. Conclusions: The ATAS intervention, in low income primary care centers, significantly increased the probability of stabilizing the metabolic control of patients with DM2 and improved their use of health services.