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Resumen Este estudio tuvo como objetivo comprender el proceso de cambio psicoterapéutico desde las perspectivas subjetivas de adolescentes y terapeutas que participaron en una terapia. Método: se utilizó un enfoque cualitativo; la recolección de información se realizó a través de entrevistas semiestructuradas audiograbadas, luego de finalizar la terapia. Participaron 17 díadas terapéuticas (adolescentes: edad promedio 15,8 años; 64,7% género femenino; terapeutas: edad promedio 30,3 años; 55,5 % género femenino), que realizaron sus terapias en contextos naturales y con diferentes enfoques teóricos. Codificadores entrenados analizaron los datos a través de los procedimientos propuestos por la Teoría Fundamentada, codificación abierta y axial, y procesos de reorganizaciones y triangulaciones permanentes. Resultados: se identificaron dos fenómenos comprensivos relacionados con los procesos de cambio psicoterapéutico: (a) El encuentro con "otro" como plataforma segura y sustrato relacional generador del cambio y, (b) El cambio como empoderamiento y desarrollo. Discusión: se examina el rol central que ocupan la relación terapéutica y el logro de las tareas del desarrollo (identidad, autonomía y autodeterminación) en el cambio psicoterapéutico. Además, se reflexiona acerca de las habilidades y acciones de los terapeutas.
Abstract This study aimed to understand the process of psychotherapeutic change from the subjective perspectives of adolescents and therapists who participated in therapy. Method: A qualitative approach was used; information was collected through a semi-structured audio-recorded interview, which occurred at the end of therapy. The participants were 17 therapeutic dyads (adolescents: average age 15.8 years; 64.7% female gender; therapists: average age 30.3 years; 55.5% female gender), who performed their therapies in natural contexts and with different theoretical approaches. Trained coders analyzed the data through the procedures proposed by the Grounded Theory, with open and axial coding, performing processes of permanent reorganizations and triangulations. Results: The results show two major phenomena related to the processes of change: (a) The encounter with "the other" as a safe platform and relational substrate to generate change and (b) Change as empowerment and development. Discussion: The central role of the therapeutic relationship and the achievement of developmental tasks (identity, autonomy and self-determination) in psychotherapeutic change is discussed. In addition, it also reflects on the skills and actions of the therapists.
RESUMEN
Background: Emotions are generic and central to most of the theories and therapies in psychology as well as an important criterion in the psychopathology of various psychiatric disorders. Though the terminology and techniques are varied, every school of therapy attempts to address emotions. Recently there is an increased focus on addressing emotions in psychotherapy. Objective: This paper aims to trace the significance given to emotions in psychological theories and therapies as well as to understand and evaluate the current status of therapeutic interventions addressing emotions. Discussion: There is obvious increase in the importance given to addressing and assessing of emotions. Emotions have become the focus of therapy and an important outcome variable in many recent therapies. However, there is still a lack of systematic assessment methods, measures as well as specific therapeutic components to address emotions. There is also lack of clarity in the terminologies used to refer to ‘emotions’. Finally, the processes and therapeutic factors leading to better emotional regulation are in their nascence and needs systematic exploration. Conclusion: Certain processes such as experiencing deep affect in therapy, depth of processing, reflection on emotions, understanding roots of emotions and using positive emotions to deal with negative emotions are seen to result in positive change. However, there is need for uniform use of terminologies, quantitative and qualitative assessment and methodologies and theoretically grounded therapeutic components to address ‘emotions’ in Psychotherapy.
RESUMEN
A questionnaire was constructed for the measurement of the change processes that are proposed by the Transtheoretical Model (TTM), applied to understanding of the consumption of alcohol in high school and university students from Bogota (Colombia). The instrument supplements others that had intended before as a part of the Questionnaire of Stages for the Modification of the Abuse (CEMA). The questionnaire was applied to 2473 subjects, most of which were high school students that participated in a program of primary prevention of the excessive consumption of alcohol. The results showed that the questionnaire has a good construction validity and a high reliability, although recommendations are suggested for its improvement toward future applications. A progression was observed in the use of cognitive-affective (experiencial) processes as the participants advance from early stages (non-contemplation, precontemplation, and contemplation), and of action processes as participants advance to preparation and action stages; this observation is coherent with the previous literature about the processes of change proposed by the TTM and its integration with the motivational stages of change in substance consumers. It is suggested that the processes of change represent copping strategies that are adjusted to the handling of psychosocial variables proposed by the cognitive-social models about the healthy behavior change, which play a differential role through the stages of change proposed by the TTM. This fact has implications of importance in the design and execution of the programs of primary and secondary prevention of the excessive consumption of alcohol.
Se construyó un cuestionario para la medición de los procesos de cambio propuestos por el Modelo Transteórico (MTT), aplicados al consumo de alcohol en estudiantes de secundaria y estudiantes universitarios de Bogotá (Colombia). El instrumento complementa a otros que se habían construido antes, como parte del Cuestionario de Etapas para la Modificación del Abuso (CEMA). La prueba se aplicó a 2473 sujetos, la mayoría de los cuales eran estudiantes de bachillerato que participaban en un programa de prevención primaria del consumo excesivo de alcohol. Los resultados mostraron que la prueba tiene una buena validez de construcción y una alta confiabilidad, aunque se realizan recomendaciones para su mejoramiento hacia aplicaciones futuras. Se observó una progresión en el uso de los procesos cognitivo-afectivos (experienciales) a medida que los sujetos avanzan desde las etapas motivacionales anteriores a la acción (no-contemplación, precontemplación y contemplación) hacia la preparación; y una progresión de los procesos conductuales a medida que los sujetos se adentran en la ejecución del cambio conductual; esta observación es coherente con la literatura previa acerca de los procesos de cambio propuestos por el MTT y su integración con las etapas motivacionales en sujetos consumidores de sustancias. Se sugiere que los procesos de cambio representan estrategias de afrontamiento que se ajustan al manejo de diversas variables psicosociales propuestas por los modelos cognitivo-sociales acerca del cambio de la conducta saludable, las cuales juegan un papel diferencial a través de las etapas propuestas por el MTT; este hecho tiene implicaciones de importancia para el diseño y ejecución de los programas de prevención primaria y secundaria del consumo excesivo de alcohol.