ABSTRACT
BACKGROUND: Aversive control techniques involve aversive stimuli to generate behavioral change. The purpose of this work is to analyze the use of verbal aversive control by psychologists during the clinical interaction, combining respondent and operant explanations. METHOD: observational methodology is used to analyze 26 session recordings of three different cases of anxiety disorder, relationship problem and low mood problem (27h 32') carried out by two psychologists of the Therapeutic Institute of Madrid. The variables considered were psychologists' aversive and non-aversive verbalizations and clients' antitherapeutic verbalizations. RESULTS: there is a strong relationship between clients' antitherapeutic verbalizations and psychologist's aversive verbalizations, both potential punishments (aversive verbalizations contingent on the client's response) and aversive pairings. Additionally, the possible psychologists' aversive verbalizations are accompanied by other verbalizations aimed to induce clients' non-problematic behaviors. CONCLUSIONS: This work opens a new way to an explanation of therapeutic change using learning processes (both respondent and operant conditioning) that take place through verbal interaction in clinical context
ANTECEDENTES: el término control aversivo se refiere a las situaciones en las que se genera un cambio conductual mediante el uso de estímulos que provocan algún tipo de malestar. En este trabajo analizamos el uso de verbalizaciones aversivas por parte del terapeuta durante la interacción clínica, combinando explicaciones pavlovianas y operantes. MÉTODO: mediante metodología observacional se analizaron 26 grabaciones de tres casos de ansiedad, problemas de pareja y bajo estado de ánimo (27h 32') tratados por dos terapeutas del Instituto Terapéutico de Madrid. Las variables consideradas fueron las verbalizaciones aversivas y no aversivas del terapeuta y las verbalizaciones antiterapéuticas del cliente. RESULTADOS: hay una fuerte correlación entre las verbalizaciones antiterapéuticas de los clientes y las verbalizaciones aversivas del terapeuta, tanto en forma de potenciales castigos (verbalizaciones aversivas contingentes a la respuesta del cliente) como de emparejamientos aversivos. Además, se comprueba que el posible control aversivo que ejerce el terapeuta se acompaña de otras acciones verbales encaminadas a desarrollar comportamientos no problemáticos en los clientes. CONCLUSIONES: trabajo preliminar que abre una nueva vía a la explicación del cambio terapéutico a partir de los procesos de aprendizaje (pavlovianos y operantes) que ocurren durante la interacción verbal en el contexto clínico
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aversive Therapy/methods , Interpersonal Relations , Mood Disorders/therapy , Psychology , Verbal Behavior , Anxiety Disorders/psychology , Anxiety Disorders/therapy , Behavior Control/methods , Conditioning, Classical , Conditioning, Operant , Mood Disorders/psychologyABSTRACT
BACKGROUND: Aversive control techniques involve aversive stimuli to generate behavioral change. The purpose of this work is to analyze the use of verbal aversive control by psychologists during the clinical interaction, combining respondent and operant explanations. METHOD: Observational methodology is used to analyze 26 session recordings of three different cases of anxiety disorder, relationship problem and low mood problem (27h 32') carried out by two psychologists of the Therapeutic Institute of Madrid. The variables considered were psychologists' aversive and non-aversive verbalizations and clients' antitherapeutic verbalizations. RESULTS: There is a strong relationship between clients' antitherapeutic verbalizations and psychologists' aversive verbalizations, both potential punishments (aversive verbalizations contingent on the client's response) and aversive pairings. Additionally, the possible psychologists' aversive verbalizations are accompanied by other verbalizations aimed to induce clients' non-problematic behaviors. CONCLUSIONS: This work opens a new way to an explanation of therapeutic change using learning processes (both respondent and operant conditioning) that take place through verbal interaction in clinical context.
Subject(s)
Anxiety Disorders/therapy , Aversive Therapy/methods , Interpersonal Relations , Mood Disorders/therapy , Psychology , Verbal Behavior , Adult , Anxiety Disorders/psychology , Behavior Control/methods , Conditioning, Classical , Conditioning, Operant , Female , Humans , Male , Middle Aged , Mood Disorders/psychologyABSTRACT
Todays clinical psychology advocates for empirically validated treatments. This supports the need for outcome-driven research, but may overlook the importance of process-driven research, which can respond to the question of why psychological treatments work. Functional analysis of behaviour has received a new boost with the emergence of the third wave of psychological therapies, which stress the importance of verbal behaviour in therapy as a way to access and modify client problems. The case presented in this work was analysed in order to make an approach to the strengthening processes that take place in therapy through verbal interaction. First, we developed and applied a categorization system of clients adaptive verbalizations. We found that this type of verbalizations increase significantly after the first few sessions, remain high in the middle sessions, and gradually decrease towards the end of the therapy. We subsequently developed and used a system of categorization of therapists verbal behaviour. We found that agreeable verbalizations were concentrated in the middle sessions, being replaced by other verbalizations in the final sessions
La psicología clínica actual es partidaria de los tratamientos validados empíricamente, lo cual invoca la necesidad de una investigación guiada por los resultados, si bien puede soslayar la importancia de la investigación quiada por los procesos, que puede responder a la pregunta de por qué funcionan los tratamientos psicológicos. El análisis funcional de la conducta ha recibido un nuevo impulso con la emergencia de la tercera ola de terapias psicológicas, que destaca la importancia del comportamiento verbal en la terapia como una manera de acceder a los problemas del cliente y modificarlos. El caso que se presenta en este trabajo nos permitirá acercarnos a los procesos reforzadores que tienen lugar en la terapia debidos a la interacción verbal. En primer lugar hemos desarrollado y aplicado un sistema de caracterización de las verbalizaciones adaptativas del cliente. Observamos que este tipo de verbalizaciones aumenta significativamente transcurridas las primeras sesiones, se mantiene elevado en las sesiones intermedias y disminuye paulatinamente hacia el final de la terapia. Posteriormente elaboramos y utilizamos un sistema de categorización del comportamiento verbal del terapeuta, observando que las verbalizaciones se concentraban en las sesiones intermedias y eran sustituidas por otras verbalizaciones en las sesiones finales
Subject(s)
Adult , Female , Humans , Psychology, Clinical/education , Psychology, Clinical , Psychoanalytic Therapy/ethics , Psychoanalytic Therapy/methods , Biomedical Research/methods , Biomedical Research/standards , Psychology, Clinical/methods , Psychology, Clinical/standards , Psychoanalytic Therapy/classification , Psychoanalytic Therapy , Biomedical Research/classification , Biomedical Research/economics , Observational StudyABSTRACT
BACKGROUND: The paper "Why do people change in therapy? A preliminary study" (2006), published in this journal, led to the beginning of a line of research based on observational methodology and aimed at the clarification of the therapeutic process. Throughout these years, significant progress has been made towards an explanation of clinical change. In this paper, a synthesis of this line of research is presented, along with a series of conclusions that can, to some extent, provide an answer to the questions we posed in the aforementioned first paper. METHOD: Verbal behavior both of therapist and client was coded for 92 clinical sessions using the Verbal Behavior Interaction Category System (SISC-INTER-CVT). Descriptive and sequential analyses of the observations were then performed. RESULTS: The data show the existence of certain patterns of verbal interaction that are related to the clinically relevant activities undertaken by the therapist, from which a model for verbal interaction in the clinical context was developed. CONCLUSIONS: The functional analysis of the therapist-client verbal interaction is essential for the comprehension of the processes that explain clinical change as well as for the improvement of the quality of psychological therapy.
Subject(s)
Behavior Therapy , Models, Psychological , Professional-Patient Relations , Adult , Communication , Conditioning, Operant , Female , Humans , Male , Middle Aged , Patient Compliance , Verbal Behavior , Young AdultABSTRACT
BACKGROUND: The paper 'Why do people change in therapy? A preliminary study' (2006), published in this journal, led to the beginning of a line of research based on observational methodology and aimed at the clarification of the therapeutic process. Throughout these years, significant progress has been made towards an explanation of clinical change. In this paper, a synthesis of this line of research is presented, along with a series of conclusions that can, to some extent, provide an answer to the questions we posed in the aforementioned first paper. METHOD: Verbal behavior both of therapist and client was coded for 92 clinical sessions using the Verbal Behavior Interaction Category System (SISC-INTER-CVT). Descriptive and sequential analyses of the observations were then performed. RESULTS: The data show the existence of certain patterns of verbal interaction that are related to the clinically relevant activities undertaken by the therapist, from which a model for verbal interaction in the clinical context was developed. CONCLUSIONS: The functional analysis of the therapist-client verbal interaction is essential for the comprehension of the processes that explain clinical change as well as for the improvement of the quality of psychological therapy
ANTECEDENTES: el artículo publicado en esta revista '¿Por qué la gente cambia en terapia? Un estudio preliminar' (2006) supuso el inicio de una línea de investigación basada en metodología observacional, dirigida a clarificar el proceso terapéutico. A lo largo de estos años han sido grandes los avances en la explicación del cambio clínico. En este artículo se presenta una síntesis de esta línea de investigación, aportando una serie de conclusiones que, en cierta medida, dan respuesta a muchos de los interrogantes que presentábamos en ese primer trabajo al que hacíamos referencia. MÉTODO: se registró la conducta verbal de terapeutas y clientes en 92 sesiones clínicas, mediante el sistema de categorización de la interacción de la conducta verbal en terapia (SISC- INTER- CVT). A continuación, se realizó un análisis descriptivo y secuencial de las observaciones. RESULTADOS: los datos mostraron la existencia de ciertos patrones de interacción verbal, relacionados con las actividades clínicamente relevantes desempeñadas por el terapeuta, a partir de los cuales se desarrolló un modelo de interacción verbal en el contexto clínico. CONCLUSIONES: el análisis funcional de la interacción verbal terapeuta-cliente resulta imprescindible para comprender los procesos que explican el cambio clínico y aumentar la calidad de la terapia psicológica
Subject(s)
Female , Humans , Male , Verbal Learning/classification , Therapeutics/nursing , Therapeutics/psychology , Occupational Health Physicians/ethics , Occupational Health Physicians/psychology , Verbal Learning/physiology , Therapeutics/instrumentation , Therapeutics/methods , Occupational Health Physicians/standards , Occupational Health Physicians , Observational StudyABSTRACT
En el presente trabajo ofrecemos una aproximación descriptiva al estudio de las instrucciones en terapia como paso previo al estudio de la influencia de las instrucciones en la adhesión terapéutica. Se analizaron dos casos completos tratados por dos terapeutas de orientación conductual, uno experto y uno inexperto. Se observaron y registraron las sesiones clínicas por medio de un sistema de categorías utilizando el software The Observer XT. Los datos ponen de relieve ciertas diferencias en la frecuencia y el tipo de instrucciones dadas, según las tareas realizadas por el clínico dentro de sesión y la experiencia de éste. Los resultados permiten establecer unas hipótesis (a confirmar) sobre la existencia de patrones a la hora de instruir al cliente durante la terapia y establecer algunas bases para estudiar la influencia de las instrucciones sobre la adhesión terapéutica y poder mejorar la eficacia de las intervenciones psicológicas (AU)
This paper presents a first descriptive approach to the study of instructions in therapy as a previous step to a more comprehensive research about the influence of instructions on therapeutic adherence. Two cases treated by two behavioral therapists were analyzed throughout the treatment -one of them was an experienced therapist and the other was inexperienced one. The sessions were observed and registered with a specific coding system and The Observer XT software. Data highlight the differences in frequency and type of instructions depending on the tasks carried out by the therapists, as well as on their experience. Results provide some first hypotheses (to be proved) about the existence of different patterns of therapist instructions during the psychological treatment and allow us to establish some bases for the study of the influence of instructions on therapeutic adherence which may improve the effectiveness of psychological interventions (AU)
