Fortalezas de carácter en pacientes adultos en tratamiento psicoterapéutico / Character strengths in adult patients in psychotherapeutic treatment

RESUMEN

Resumen La investigación que se informa tuvo como objetivos: 1) estudiar las 24 fortalezas de carácter en pacientes adultos que se encuentran en diferentes etapas de un tratamiento cognitivo conductual psicoterapéutico naturalista; y 2) analizar la relación de las fortalezas con algunas del progreso durante el tratamiento, la alianza terapéutica y la adherencia al tratamiento desde la perspectiva del terapeuta. Se contó con una muestra intencional de 85 pacientes adultos de ambos sexos en tratamiento psicoterapéutico ambulatorio y sus respectivos terapeutas. Se utilizaron una hoja de datos demográficos y del tratamiento, el Inventario de Fortalezas y Virtudes y una encuesta de opinión para el terapeuta. Los resultados mostraron que los pacientes en la etapa final presentan una mayor fortaleza de Autorregulación. Los pacientes con depresión presentaban menores fortalezas de apertura mental y capacidad de perdonar, en comparación con pacientes con trastornos de ansiedad y con trastornos comórbidos ansioso-depresivos. Aquellos pacientes que habían tenido un tratamiento psiquiátrico previo presentaban menores niveles de la fortaleza persistencia. Un mayor tiempo de tratamiento se asoció con mayores niveles de las fortalezas Liderazgo y curiosidad, en tanto que un mayor malestar psicológico se vinculó con una disminución de una alta cantidad de fortalezas. La fortaleza espiritualidad se halló significativamente asociada al progreso en el tratamiento según su terapeuta. Una mayor apertura mental se halló vinculada a mayor adherencia a horarios, sugerencias y mejor vínculo terapéutico según la opinión del terapeuta. El estudio del funcionamiento positivo en pacientes permitirá enriquecer la psicología clínica para convertirse en una disciplina más integradora.

ABSTRACT

Abstract The study of positive traits or strengths has been the cornerstone of positive psychology. Positive psychology assumes that positive variables are different in nature from psychopathological variables and they do not necessarily improve with a usual psychotherapeutic treatment. They would require another type of intervention to progress a positive intervention. Studies on character strengths in the clinical population are very scarce and, in general, focused on depression. Previous studies found that higher levels of hope, vitality, spirituality and leadership strengths were related to lower levels of anxiety and depression. In addition, lower levels of gratitude have been linked to symptoms of depression. The study of strengths and progress during treatment is very limited, whereas the relationship between strengths of character and treatment process has not yet been investigated. This research aims to 1) study the 24 character strengths in adult patients who are at different stages of a naturalistic cognitive behavioral treatment; and 2) to analyze the relationship of character strengths with progress during treatment, therapeutic alliance and adherence to treatment from the therapist's perspective. Therapist's report has proven to be a very valuable source of information about the therapeutic process and outcome. An intentional sample of 85 adult outpatients (25 men and 60 women) was used and their respective therapists (11 men and 7 women). Patients had mainly anxiety, depressive or comorbid anxiety-depressive disorders; 22 were in the initial stage, 46 in the intermediate stage and 17 in the final stage of treatment.They completed a demographic and treatment datasheet, the Inventory of Strengths and Virtues and the therapist filled in an opinion survey. The study was cross-sectional. The treatment was cognitive-behavioral. The therapists did not receive any training or instruction during study, the treatment was "as usual". Stages of treatment, initial, intermediate or final, were assigned by the therapist. The results showed that patients in the final stage have greater self-regulation strength. In this strength, there are no differences between patients at initial and intermediate stages of treatment but it increases significantly in the group that was finishing treatment. It should also be noted that in the 23 remaining strengths there are no differences among patients at the different stages of treatment. Patients with depression had lower strengths of open-mindedness and forgiveness compared to patients with anxiety disorders and comorbid anxiety-depressive disorders. Those patients who had had a previous psychiatric treatment had lower levels of Persistence strength. However, no differences were found between patients who had a previous psychological treatment and those who had not. A longer duration of treatment was associated with higher levels of leadership and curiosity strengths, while greater psychological distress was associated with a decrease in a high number of strengths. The strength spirituality was found to be significantly associated with progress in treatment according to the therapist. A greater open-mindedness was associated with better adherence to schedules, suggestions and therapeutic alliance according to the therapist´s opinion.The association between character strengths and the therapist's opinion has been mild to moderate, which is expected for being a hetero-report. This has been the first study to compare the character strengths between patients at different stages of a naturalistic psychotherapeutic treatment and to include patients with anxiety disorders. This research provided a first approach to the relationship between character strengths and the therapist's perception of progress in therapy and some treatment process related variables. The study of positive functioning in patients will enrich clinical psychology to become a more integrative discipline. In this way, the goal of therapy will not only be to alleviate the negative symptoms, but also to help individuals build a full life.