Tracking Psychodynamic Foci: Trajectories Through the Therapeutic Process.

Brief psychodynamic psychotherapy has gained importance in current clinical practice. To achieve brevity, a focus must be established and worked through. Different conceptualizations have emphasized the relational patterns and/or conflict foci as central but adopting a mono-schematic approach. However, patients come to treatment with more than one issue that must be addressed. Thus, another focus must be included because of its relevance, i.e., personality functioning. The aims of this study were to identify the presence and depth level of three foci (relational pattern, conflict, and personality functioning) in episodes of change throughout the process, and to evaluate the relationship of each focus with the complexity of patients' change. Initial OPD foci and the presence and depth of each were evaluated in 13 successful brief psychodynamic therapies. Change episodes of those therapies were analyzed as well. Results showed differences between foci in the initial phase with a higher presence of conflict focus. Throughout the process, only the presence and level of personality functioning improved. Also, complexity of patients' change was related to conflict focus, specifically on the emergence of competence feelings. The results provide evidence and enrich process research of brief psychodynamic therapies.

Como ocorre a mudança em psicoterapia? Um estudo empírico do processo de uma psicoterapia breve / How change occurs in psychotherapy? An empirical study of a brief psychotherapy process / ¿Como ocurre el cambio en la psicoterapia? Un estudio empírico del proceso de una psicoterapia breve

Este estudo visa descrever o processo psicoterapêutico de um caso de Psicoterapia Psicodinâmica Breve (PPB) e examinar a relação entre as variáveis do processo com o curso do tratamento. O caso era de uma paciente com queixas depressivas e sintomas somáticos, atendida por psicoterapeuta experiente. Para avaliação do processo terapêutico, todas as sessões do tratamento (n=11) foram classificadas com o Psychotherapy Process Q-Set (PQS). As médias dos 100 itens do PQS em todo o tratamento foram ordenadas para identificar os itens mais e menos característicos do processo. Para examinar quais as variáveis da terapeuta, da paciente e da interação se modificaram no transcorrer do tratamento, os itens do PQS foram correlacionados com o número da sessão. As características gerais são consistentes com o pressuposto da existência de um continnum expressivo-suportivo nas psicoterapias psicodinâmicas. Conforme o processo evoluiu, constatou-se uma tendência crescente da terapeuta em adotar uma postura mais apoiadora e menos expressiva, enquanto observou-se autonomia crescente da paciente. O movimento complementar da díade associado à flexibilidade da técnica parecem ter contribuído para a mudança observada.

This study aims at describing the psychotherapeutic process of a Brief Psychodynamic Psychotherapy case and to examine the relationship between process variables and treatment course. The case is of a patient with depressive symptoms and somatic complaints treated by an experienced psychotherapist. For the therapeutic process evaluation, all treatment sessions (n=11) were rated with the Psychotherapy Process Q-Set (PQS). The means of PQS in the entire treatment were sorted to identify the most and the least characteristic items of the process. To examine which variables of the therapist, of the patient, and of the interaction have changed over the course of treatment, the PQS items were correlated with the session number. The process' general characteristics are consistent with the assumption of a supportive-expressive continuum in psychodynamic psychotherapies. As the process progressed, it was noticed that the therapist adopted a more supportive and less expressive attitude, and that patient became more autonomous. The complementary roles of the dyad associated with technical flexibility seem to contribute to the observed changes.

Este estudio tiene como objetivo describir el proceso psicoterapéutico de un caso de Psicoterapia Psicodinámica Breve y examinar la relación entre las variables del proceso y el curso del tratamiento. El caso es de una paciente con síntomas de depresión y quejas somáticas atendida por una experimentada psicoterapeuta. Para la evaluación del proceso terapéutico, todas las sesiones de tratamiento (n=11) fueron clasificadas con el Psychotherapy Process Q-Set (PQS). Las medias del PQS durante todo el tratamiento fueron ordenadas para identificar ítems más y menos característicos del proceso. Para analizar las variables de la terapeuta, de la paciente y de la interacción que cambiaron en el curso del tratamiento, los ítems del PQS fueron correlacionados con el número de la sesión. Las características generales del proceso son consistentes con la hipótesis de la existencia de un continuo de apoyo y expresión en las psicoterapias psicodinámicas. A medida que el proceso se desarrolló, hubo una tendencia cada vez mayor de la terapeuta a adoptar una postura más apoyadora y menos expresiva, mientras había una creciente autonomía del paciente. El movimiento complementar de la díada, asociado a la flexibilidad técnica parecen ter contribuido para el cambio observado.