Concepción de la Psicoterapia. Aproximación Cualitativa desde la Teoría Fundamentada / Conception of Psychotherapy. Qualitative Approach from Grounded Theory

Resumen El objetivo de esta investigación fue describir, cualitativamente y en profundidad, la concepción de la práctica de la psicoterapia en psicólogos venezolanos. Sobre la base de la teoría fundamentada, se procesaron las entrevistas realizadas a siete psicólogos con una experiencia profesional de al menos un lustro, con diversos enfoques terapéuticos en sus prácticas clínicas. Los resultados revelan que los entrevistados conciben la psicoterapia como un proceso basado en una relación que conduce al crecimiento personal, tanto del paciente como del terapeuta, por lo que la dimensión intersubjetiva y relacional -aunque asimétrica- está implícita en su práctica clínica. Se determinó que, de acuerdo con sus experiencias, el éxito del proceso psicoterapéutico depende del establecimiento de una positiva relación terapéutica, porque esta favorece el surgimiento de aspectos íntimos y subjetivos del paciente en el proceso terapéutico. Se concluye que la dimensión intersubjetiva en el proceso psicoterapéutico es esencial y debe estar presente en la conceptualización de la psicoterapia.

Abstract The main objective of this research was to qualitatively and indepth characterize the concept of psychotherapy of Venezuelan clinical psychologists. Based on the grounded theory, seven psychologists with different approaches and with at least 5 years of professional experience were interviewed. The results reveal that the interviewees conceive psychotherapy as a process based on a relationship that leads to personal growth, both for the patient and for the therapist, implying the intersubjective (but asymmetric) and relational dimension. It was determined that the success of the psychotherapeutic process depends on the establishment of a positive therapeutic relationship because it favors the appearance of intimate and subjective aspects of the patient in the therapeutic process. As a conclusion, the intersubjective dimension in psychotherapy is highlighted and should be incorporated into the conceptualization of psychotherapy.

Proceso de tratamiento a víctimas del crimen organizado: Un estudio cualitativo centrado en la experiencia de psicólogos clínicos / Process of treatment to victims of organized crime: A qualitative study focused on the experience of clinical psychologists

Resumen El crimen organizado representa una de las más graves problemáticas a nivel mundial. No solo por el gran número de muertes violentas y lesiones entre los grupos rivales y en la población general, sino por las afectaciones en la salud mental de las personas que viven en ciudades con alta incidencia delictiva. Las víctimas directas o indirectas del crimen organizado suelen desarrollar diversos síntomas, dependiendo del tipo de delito y el grado de violencia (intensidad y duración) a la que fueron sometidas, así como del tipo de atención recibida después del ataque. Se presentan los hallazgos de un estudio cualitativo sobre el proceso de atención a víctimas del crimen organizado, desde la perspectiva de los psicólogos clínicos. El estudio fue realizado en el estado de Tamaulipas, al norte de México. Su propósito fue conocer las fases del proceso de atención y las estrategias clínicas utilizadas, las reacciones cognitivas, emocionales y sociales generadas en los terapeutas, las estrategias de autocuidado y las limitaciones contextuales. Participaron ocho psicólogos clínicos de diferentes enfoques terapéuticos. Se realizaron entrevistas individuales semiestructuradas y fueron analizadas con el software Atlas.ti 7, en base a la Teoría Fundamentada. Los resultados indican un proceso de atención con cuatro fases: previa, inicial, tratamiento y cierre. El terapeuta emplea estrategias clínicas específicas para cada fase del tratamiento y además desarrolla estrategias para su autocuidado emocional y protección, debido a las condiciones de violencia en el contexto local.

Abstract Organized crime represents one of the most serious problems worldwide. Not only because of the large number of violent deaths and injuries among rival groups and in the general population, but also because of the mental health effects of people living in cities with a high incidence of crime. The direct or indirect victims of crimes such as homicide, kidnapping, extortion, human trafficking, robbery with violence, rape, among others, often develop various symptoms depending on the type of offense, the degree (intensity and duration) of violence to which they were subjected, and the care (medical, psychological, legal) received after the attack. This paper presents the findings of a qualitative study on the process of care for victims of organized crime from the perspective of clinical psychologists. It was conducted in the state of Tamaulipas, in northern Mexico. The purpose of the study was to know the phases of the psychological care process and the clinical strategies used; the cognitive, emotional and social reactions generated in the therapists; the self-care strategies used by psychologists, and the contextual limitations for care. Eight clinical psychologists from different therapeutic approaches participated. Semi-structured interviews were conducted and analyzed with the Atlas.ti 7 software, based on Grounded Theory. The results indicate a process of attention with four phases: previous, initial, treatment and closure. In the previous phase, participants identify adult men and women as the main victims of organized crime who attend therapy. Direct victims come for crimes such as kidnapping and extortion. Indirect victims are usually close relatives of the direct victims and come for crimes such as homicide, forced disappearance and kidnapping. In the initial phase, psychologists use the therapeutic alliance, rapport, empathy and the promotion of attachment to treatment. Psychologists with private practice can perform specific actions such as attending the patient's home when the patient is afraid to leave. The most frequent diagnoses found in this phase are post-traumatic stress disorder, depressive disorders, and anxiety disorders. The treatment phase is characterized by the diversity of techniques used according to the therapeutic model adopted by each psychologist. The closing phase occurs when the patient has emotionally stabilized and therapists seek relapse prevention, so they follow up on cases. During the process of care for victims, therapists have different cognitive, emotional and social reactions; and develop strategies for their personal care, due to the conditions of violence that are experienced in the local context. The most used self-care strategies are to attend a personal therapeutic process, supervise the cases, exercise, eat well, express their emotions, go to natural environments to distract themselves and reduce the number of cases they attend. Among the limitations identified in the process of care for victims of organized crime, therapists mention the need for specialized training, including not only their professional training, but have a procedure or a specific protocol to deal with such cases.

Análisis psicométrico de la escala de conductas de autocuidado para psicólogos clínicos / Psychometric examination of the Self-Care Behaviors Scale for Clinical Psychologists

En este artículo se describe el examen psicométrico de la Escala de Conductas de Autocuidado para psicólogos clínicos (EAP; Guerra, Rodríguez, Morales & Betta, 2008). Este instrumento fue diseñado para medir la frecuencia de emisión de conductas de autocuidado en psicólogos que trabajan realizando psicoterapia. Una muestra de 159 psicólogos clínicos chilenos respondió la EAP y una serie de instrumentos destinados a evaluar la validez convergente de la escala. La EAP reveló ser un instrumento confiable y válido. En particular, esta escala obtuvo adecuados índices de consistencia interna y adoptó una estructura unifactorial coherente con la teoría que la sustenta. Además, la escala mostró adecuados índices de validez convergente, al correlacionar del modo esperado las tres dimensiones del síndrome de burnout, con los niveles de ansiedad y con una puntuación general de la calidad de vida de los participantes. Finalmente se discuten las implicancias de estos resultados.

This study describes the psychometric examination of the Self-Care Behaviors Scale for Clinical Psychologists (EAP; Guerra, Rodríguez, Morales & Betta, 2008) a scale designed to measure the frequency of self-care behaviors in psychologists dedicated to treat patients. A sample of 159 clinical psychologists from Chile completed the EAP and a series of instruments destined to evaluate the convergent validity of the scale. The EAP showed to be a reliable and valid instrument. In particular, the scale showed adequate indexes of internal consistency and adopted a unifactorial configuration coherent with the theory. In addition the scale showed convergent validity when correlating, as expected, with the levels of three dimensions of the burnout, with the levels of anxiety, with the levels of secondary traumatic stress and with a general score of the quality of life of the participants. Finally the consequences of these results are discussed.

Efectos de una intervención cognitivo-conductual en el aumento de conductas de autocuidado y disminución del estrés traumático secundario en psicólogos clínicos / Effects of a cognitive-behavioral treatment on the increase of self-care behaviors and decrease of secondary traumatic stress on clinical psychologists

En la presente investigación se evalúa la efectividad de un taller de autocuidado de orientación cognitivo conductual diseñado para ser aplicado a psicólogos clínicos con altos niveles de estrés traumático secundario. El objetivo del taller es aumentar la frecuencia de emisión de conductas de autocuidado y disminuir los niveles de estrés traumático secundario en los psicólogos. Mediante un diseño cuasi-experimental se evalúan los efectos del taller. Los resultados indican que, después de las 5 sesiones que dura el taller, los psicólogos que participaron en él (n=9) aumentaron significativamente sus conductas de autocuidado y disminuyeron significativamente sus niveles de desgaste. En cambio, los psicólogos que no participaron del taller (n=12) no variaron en la frecuencia del autocuidado y aumentaron el estrés traumático secundario. En virtud de estos resultados se concluye que el taller es efectivo y se constituye como una alternativa para prevenir y tratar el desgaste laboral en psicólogos clínicos.

In the present investigation, we evaluate the effectiveness of a group therapy program for self-care with cognitive-behavioral orientation, designed to be used on clinical psychologists with high levels of secondary traumatic stress. The object of this group therapy program is to increase the frequency of emissions of self-care behaviors and decrease the levels of secondary traumatic stress in psychologists. By a quasi-experimental design, we evaluate the group therapy program effects. The results indicate that, after 5 sessions that lasts the group therapy program, the psychologists that participated in it (n = 9) increased significantly their self-care behaviors and decreased significantly their secondary traumatic stress levels. Instead, the psychologists that did not participate in the group therapy program (n = 12) did not show variation on self-care frequency and they increased secondary traumatic stress. These results are conclusive that the group therapy program is effective and it represents an alternative to prevent and treat work related burnout in clinical psychologists.