ABSTRACT
RESUMO Objetivo Compreender os sentidos que o vínculo terapêutico assume para fonoaudiólogos clínicos. Método A pesquisa foi aprovada por Comitê de ética, sendo de caráter transversal, de abordagem quanti-qualitativa, pautada na Análise do Conteúdo. A pesquisa contou com a participação de 96 profissionais fonoaudiólogos clínicos, inscritos no Conselho de Fonoaudiologia da 3ª região (CRFa 3), o qual abrange os Estados do Paraná e de Santa Catarina. Resultados Dos 96 fonoaudiólogos incluídos, parte significativa dos participantes definiram o vínculo terapêutico como sendo relação/interação. Referente ao papel do vínculo para o trabalho clínico fonoaudiológico, a maioria dos profissionais o descreveu como base fundamental e outra parte deles afirmou que tal vínculo é necessário para a evolução/desenvolvimento do paciente. Conclusão É possível compreender que, de acordo com os participantes, a relação terapêutica é essencial para a sustentação e manutenção do trabalho clínico fonoaudiológico, impactando na ressignificação da queixa e na minimização do sofrimento dos usuários.
ABSTRACT Purpose To understand the meanings that the therapeutic bond assumes for clinical speech therapists. Methods The research was approved by the Ethics Committee, being of a transversal character, with a quantitative-qualitative approach in the Content Analysis. The research with the participation of 96 clinical speech therapists, registered in the Speech Therapy Council of the 3rd region (CRFa 3), which covers the States of Paraná and Santa Catarina. Results Of the 96 speech therapists included, a significant part of the participants defined the therapeutic bond as a relationship/interaction. Regarding the role of the bond for the speech therapy clinical work, most professionals declared theirs as a fundamental basis and another part of the bond is necessary for the evolution/development of the patient. Conclusion It is possible to understand that, according to the therapeutic patients, it is essential to sustain, maintain the clinical work for users, impacting the resignification of the complaint and the minimization of the users' suffering.
ABSTRACT
A relação médico-paciente, em oncologia, adquire uma particular importância devido à gravidade da doença e ao estigma que muitas vezes acompanha a experiência do paciente. Esta pesquisa teve como objetivo analisar percepções e dificuldades que os médicos vivenciam frente ao paciente oncológico. Trata-se de um estudo qualitativo, baseado principalmente em entrevistas abertas e aprofundadas, realizado com vinte médicos que trabalham no Instituto do Câncer do Ceará. Baseando-se na convivência da Dra. Sheila com seus pacientes, Cássio e Elisa, personagens fictícios de uma crônica entremeada na discussão do artigo, ilustram-se os principais registros encontrados. Procurou-se abordar quatro temas centrais: a construção do vínculo, o desempenho de habilidades comunicacionais, a abordagem terapêutica e a interação com a família. O sofrimento e as implicações emocionais de pacientes e familiares, as diferenças comunicacionais existentes entre os médicos entrevistados, principalmente em referência à transmissão do diagnóstico e à terapêutica, tornam-se fatores importantes que influenciam a relação e o estabelecimento ou não do vínculo terapêutico. Diante disso, vê-se ser necessário estudos e debates acerca do tema, visando a uma incorporação desta temática na formação médica.
In oncology the doctor-patient relationship has a particular importance due to the gravity of the illness and to the stigma that is followed many times by the experience of the patient. This research was designed to analyze perceptions and difficulties that doctors face when they are dealing with oncology patient. It is a qualitative study, based mainly on open and in-depth interviews, involving 20 doctors from the Cancer Institute of Ceará. From the relationship of Dr. Sheila with her patients, Cássio and Elisa, fictitious personages of a chronicle larded in the quarrel of the article, the main facts are illustrated. We tried to approach four main subjects: the construction of the bond, the communication abilities performance, the therapeutic approach and the family interaction. The suffering and the emotional implications of patients and familiars, the differences in communication between the interviewed doctors, mainly in reference to the transmission of the diagnosis and the therapy, become important factors that influence the relation and the establishment or not of the therapeutic bond. Because of this, it seems to be necessary studies and debates concerning this subject, aiming at an incorporation of this thematic in the medical training.
Subject(s)
Humans , Communication , Fear , Medical Oncology , Physician-Patient Relations , Physicians/psychology , Stress, Psychological , Brazil , Stress, Psychological/epidemiologyABSTRACT
En este estudio se evalúa la efectividad de la psicoterapia individual realizada por terapeutas noveles en la Clínica Psicológica de la Universidad de La Frontera (Temuco - Chile) y su relación con la alianza terapéutica. La investigación es de carácter cuantitativo, con diseño de grupo único y evaluaciones al inicio y término de la terapia. En el estudio participaron 23 consultantes, cuyos procesos psicoterapéuticos eran conducidos por 11 estudiantes de los últimos niveles de la Carrera de Psicología, que realizaban su primera experiencia en atención psicoterapéutica supervisada, o se encontraban efectuando su práctica profesional. Los instrumentos utilizados fueron las versiones adaptadas para Chile del Outcome Questionnaire (OQ-45.2) de De la Parra y Von Bergen (2000, 2002) que permite evaluar el nivel de cambio en el curso de la terapia y sus resultados finales y del Working Alliance Inventory (Inventario de Alianza de Trabajo, IAT-P) de Santibáñez (2001) que evalúa la alianza terapéutica desde la perspectiva del paciente. Los resultados informan diferencias significativas entre la primera y última aplicación del OQ-45.2. Los puntajes obtenidos en el IAT-P están ubicados en los dos tercios superiores de la escala, observándose una restricción de rango con sesgo positivo. Se evidencia una asociación significativa entre la alianza terapéutica percibida por el paciente y el resultado de la psicoterapia, tanto en el puntaje total de la escala OQ-45.2, como en la Subescala de Síntomas. Estos resultados son discutidos considerando la investigación actual en el área y el trabajo realizado por terapeutas noveles.
The present study was aimed to assess the effectiveness of individual psychotherapy undertaken at the Psychological Clinic of the Universidad de La Frontera (Temuco, Chile) and its relationship with the therapeutic alliance. The investigation involved 23 adult patients with neurotic symptoms. Their therapeutic processes were carried out by 11 trainee students from the regular psychology training program. Out of these, 4 therapists were performing their first supervised psychotherapeutic experience, and 7 therapists were undertaking their professional training using either a psychodynamic or a humanistic- experiential approach. The therapeutic processes considered in this study lasted between 5 and 42 sessions, comprising the following closure modalities: agreed closure between the patient and therapist because of the fulfillment of objectives, closure requested by the patient, and withdrawal of the therapeutic process. The instruments used were the Outcome Questionnaire (OQ-45.2) adapted for Chilean population by De la Parra and Von Bergen (2000, 2002), an instrument that allows to evaluate the level of change in the final course of the therapy and its outcomes; and the Working Alliance Inventory (Inventario de Alianza Terapéutica, IAT-P) adapted for Chilean population by Santibánez (2001), an instrument that evaluates the level of therapeutic alliance from the perspective of the patient. The study was quantitative in nature, with a unique group design and evaluations at the beginning and at the end of the therapy. For each patient, the OQ-45.2 was administered at the end of the first, and after the last psychotherapy session. In addition, the IAT-P was administered once, at the fourth session. In order to assess the pre-post psychotherapy differences, a samples-related t test was performed. In addition, a Reliable Change Index was calculated using scores of the first and final OQ-45.2 administration; and finally, the percentage of patients with clinically significant change, was estimated. The administration of the IAT-P showed a restriction of range with positive bias both, on overall total scale scores as well on each subscale score. For this reason, using the median, two subgroups for the overall IAT were created. Also, two subgroups were generated for each subscale: a subgroup of subjects with scores higher than the median and a subgroup of subjects with scores below the median. Then, by using the Mann-Whitney U test, the Reliable Change Index from the groups with high or low levels of alliance were compared. Results of this study showed significant differences between the first and last application of the OQ-45.2. In order to estimate whether the change was clinically significant, cut-off scores and Reliable Change Index were used. In the OQ-45.2 scale, 17 patients left the clinical group, 12 people met the Reliable Change Index criterion, and 8 people showed a clinically significant change. In relation to the closure modality, 7 patients with clinically significant change ended the psychotherapy with a discharge given by the therapist, while one requested the closure of the therapy. Scores from the IAT-P were located in the upper two thirds of the scale. The Bond Subscale had the highest mean, while Tasks and Goals got a slightly lower value. With respect to the main issue, it was found a significant association between therapeutic alliance and the outcome of the psychotherapy both, on overall total scale scores of the OQ-45.2 as well Symptoms Scale of the same instrument. Results showed that the alliance between therapist and the patient especially helped to reduce patient's symptoms. In addition, it was evident that students in training were able to establish good alliance with their patients, and thus to promote the achievement of the therapeutic outcome. These results are discussed taking into account current research on this topic.