Teamwork solutions for complex problems in psychotherapy: A systems thinking-based commentary.

INTRODUCTION: Most psychological treatments are administered in a one-to-one therapy format, which has proven effective but has limitations in complex clinical situations. Teamwork can help address these limitations by going beyond the one-to-one therapy approach and involving the client's professional and relational network in therapy interventions to promote and secure change. In this issue of Journal of Clinical Psychology: In Session five effective teamwork practices are presented illustrating how clinicians integrate teamwork into treatment delivery to improve outcomes in an array of cases presenting high complexity. PURPOSE: In this commentary section, we describe the role and essence of these teamwork practices from a systems thinking approach as a theoretical umbrella to understand the diversity of processes hindering and facilitating effective teamwork CONCLUSSION: From this approach we discuss the core skills that psychotherapists should train to master team working and interprofessional collaboration. The basic professional competence consists in the ability to foster and coordinate shared frames of understanding in case formulation. An advanced systemic skill is based on the ability to formulate and change relational patterns, given that interpersonal processes are the main key factor to understand barriers and facilitators of effective teamwork to overcome stalemated complex clinical situations.

Cpt1c Downregulation Causes Plasma Membrane Remodelling and Anthracycline Resistance in Breast Cancer.

Breast cancer (BC) is the most common malignancy in women worldwide. While the main systemic treatment option is anthracycline-containing chemotherapy, chemoresistance continues to be an obstacle to patient survival. Carnitine palmitoyltransferase 1C (CPT1C) has been described as a poor-prognosis marker for several tumour types, as it favours tumour growth and hinders cells from entering senescence. At the molecular level, CPT1C has been associated with lipid metabolism regulation and important lipidome changes. Since plasma membrane (PM) rigidity has been associated with reduced drug uptake, we explored whether CPT1C expression could be involved in PM remodelling and drug chemoresistance. Liquid chromatography-high resolution mass spectrometry (LC-HRMS) lipid analysis of PM-enriched fractions of MDA-MB-231 BC cells showed that CPT1C silencing increased PM phospholipid saturation, suggesting a rise in PM rigidity. Moreover, CPT1C silencing increased cell survival against doxorubicin (DOX) treatment in different BC cells due to reduced drug uptake. These findings, further complemented by ROC plotter analysis correlating lower CPT1C expression with a lower pathological complete response to anthracyclines in patients with more aggressive types of BC, suggest CPT1C as a novel predictive biomarker for BC chemotherapy.

Fuzzy Cognitive Maps as a Tool for Identifying Cognitive Conflicts That Hinder the Adoption of Healthy Habits.

Implementing healthy lifestyle habits can take a great effort and sticking to such prescriptions is complicated. Failure rates amongst people seeking to adopt a healthier diet are estimated to be around 80%. Exploring the network of meanings that an individual associates with adopting habits such as healthy eating, maintaining the correct weight, and practising physical exercise can reveal the inconsistencies, obstacles, or psychological conflicts that hinder change and target-achievement. Fuzzy cognitive maps (FCM) can be of great utility in this task as they allow us to explore the structure of the personal meaning system of an individual as well as determine any obstacles and simulate hypothetical scenarios that project its future evolution. This can help to identify the foci of cognitive conflicts that hinder the adoption of healthy habits and establish more effective personalised intervention programmes that make it easier to maintain these habits.

Adaptation and psychometric properties of the spanish version of the yp-core (Young Person's Clinical Outcomes in Routine Evaluation).

INTRODUCTION: Given the increasing prevalence of mental health problems in the general population, it is indispensable to use assessment tools aimed to assess the outcome of therapeutic interventions in order to refine the process of psychological rehabilitation. METHOD: We describe the process of adaptation into Spanish and a first psychometric study of the Young Person's- Clinical Outcomes in Routine Evaluation (YP-CORE), an instrument designed to measure the outcome in terms of general distress of therapeutic interventions in young people (11-16 years). 104 adolescents participated in the clinical and 131 in the non-clinical samples. RESULTS: Analyses showed good levels of acceptability, adequate internal consistency and acceptable test-retest stability, with moderately high correlations between administrations. In addition, the instrument yielded significant correlations with all dimensions of the Youth Self Report, the highest being between both total scores. Crucially, discriminated between clinical and non-clinical samples and showed a small effect of age but a larger effect of gender, with higher scores for females. The Principal Component Analysis replicates the original structure. Cut-off scores to calculate the reliable and clinically significant change are provided. CONCLUSIONS: These results support initial use of the instrument though there are certain limitations that indicate the need for more research with larger and more representative samples, in which the psychometric properties of the instrument should be verified.

Adaptación y propiedades psicométricas de la versión española del yp-core (Young Person's Clinical Outcomes in Routine Evaluation) / Adaptation and psychometric properties of the spanish version of the yp-core (Young Person's Clinical Outcomes in Routine Evaluation)

Introducción. Ante la creciente prevalencia de problemas de salud mental en la población general, resulta imprescindible el uso de instrumentos de evaluación destinados a evaluar el resultado de las intervenciones terapéuticas, con el fin de facilitar el proceso de rehabilitación psicológica. Metodología. Se expone el proceso de adaptación al español y un primer estudio psicométrico del Young Person's Clinical Outcomes in Routine Evaluation (YP-CORE), un instrumento diseñado para medir el resultado de las intervenciones terapéuticas a través de la evaluación del malestar general en población infanto-juvenil (11-16 años). Para ello, se ha tenido en cuenta una muestra clínica de 104 participantes y otra no clínica de 131. Resultados. Los análisis han demostrado una buena aceptabilidad, una consistencia interna adecuada, así como una estabilidad test-retest aceptable, con correlaciones moderadamente elevadas. Además, el instrumento ha reflejado correlaciones significativas con todas las dimensiones del Youth Self Report, siendo las más elevadas entre ambas puntuaciones totales. También resulta útil a la hora de discriminar entre la población clínica y no clínica, mostrando poca influencia de la edad, pero sí del sexo, con puntuaciones más elevadas en el género femenino. El Análisis de Componentes Principales replica la estructura original. También se proporcionan los puntos de corte que servirán para calcular el cambio fiable y clínicamente significativo. Conclusiones. Los resultados expuestos permiten hacer un uso fiable del instrumento, aunque se mencionan ciertas limitaciones que sugieren la necesidad de realizar investigaciones con muestras mayores y más representativas, en las cuales se verifiquen las propiedades psicométricas del instrumento

Introduction. Given the increasing prevalence of mental health problems in the general population, it is indispensable to use assessment tools aimed to assess the outcome of therapeutic interventions in order to refine the process of psychological rehabilitation. Method. We describe the process of adaptation into Spanish and a first psychometric study of the Young Person's-Clinical Outcomes in Routine Evaluation (YP-CORE), an instrument designed to measure the outcome in terms of general distress of therapeutic interventions in young people (11-16 years). 104 adolescents participated in the clinical and 131 in the non-clinical samples. Results. Analyses showed good levels of acceptability, adequate internal consistency and acceptable test-retest stability, with moderately high correlations between administrations. In addition, the instrument yielded significant correlations with all dimensions of the Youth Self Report, the highest being between both total scores. Crucially, discriminated between clinical and non-clinical samples and showed a small effect of age but a larger effect of gender, with higher scores for females. The Principal Component Analysis replicates the original structure. Cut-off scores to calculate the reliable and clinically significant change are provided. Conclusions. These results support initial use of the instrument though there are certain limitations that indicate the need for more research with larger and more represen tative samples, in which the psychometric properties of the instrument should be verified

Características psicométricas de la versión española del Working Alliance Inventory-Short (WAI-S) / Psychometric propierties of Spanish versión of Working Alliance Inventory-Short (WAI-S)

Este artículo presenta un estudio de las características psicométricas de la versión española del Inventario de Alianza Terapéutica formato corto (WAI-S). La muestra la formaron 229 sujetos mayores de edad que recibieron tratamiento psicoterapéutico en un centro privado. La edad media de los participantes fue de 29.2 (SD= 8.84). Todos los participantes contestaron la versión española para pacientes del WAI-S al finalizar la tercera sesión de terapia El análisis factorial de ejes principales indicó que el primer factor está formado especialmente por los reactivos de la subescala tareas y vínculo, mientras que el segundo factor está formado por reactivos de las subescalas de objetivos y tareas. Es posible diferenciar entre las subescalas de la alianza terapeutica a nivel teórico, pero los datos indican que los reactivos de las subescalas de objetivos, tareas y vinculo positivo estan muy asociados. La estimación del coeficiente de fiabilidad basada en la consistencia interna de la versión española del WAIS se demostró buena. Los resultados sugieren que la alianza terapéutica puede ser un constructo más unificado (AU)

This paper presents a study of the psychometric properties of the Spanish short version of the Working Alliance Inventory. Method: 229 subjects received psychotherapy treatment in a private centre. The mean ages were 29.2 years old (SD=8.84). All patients answered the spanish version of the Working Alliance Inventory when they finished the third session of the therapy. The factor analysis indicated that the first factor is based by the items from the Tasks and Bonds subscale, whereas the second factor is based by the items from the Tasks and Goals subscale. It is possible to differentiate between the therapeutic alliance subscales in the theory level, but data show that items from Goals, Tasks and Bond are close related. Reliability coefficient based on the internal consistency of the spanish version of the Working Alliance Inventory (short version) is good. Results suggest that therapeutic alliance may be a more unified construct than is usually thought of (AU)

Análisis diferencial del proceso y resultado psicoterapéutico en función del motivo de demanda en pacientes con ansiedad y depresión / Differential Analysis of Psychotherapy Outcome and Process: Correlates of Initial Disturbance (Anxiety vs. Depression)

The study focused of the differential aspects of the psychotherapeutic process and outcome in two groups of patients who requested therapy for anxiety problems or depression. Participants were 103 people, 41 in the depression group and 62 in the anxiety one. The instruments used were the CORE Outcome Measure and the short version of the WAI (Working Alliance Inventory) to assess the therapeutic alliance. The goal of the study was to analyse the differences between the groups with respect to the therapeutic alliance, ruptures of the therapeutic relationship, the abandonment of treatment and characteristics of the therapist-client bond. Results indicated that there were no significant differences between both groups in severity of the problem, differential symptomatic improvement for any of the factors, correlation between therapeutic alliance and symptoms in the case of the depression group, therapeutic alliance in the first 12 sessions either in general or in any of its three factors, and temporary weakening of the therapeutic alliance nor temporary symptomatic relapse. However, in the case of the anxiety group the correlation between therapeutic alliance and symptoms was highly significant in all sessions from the 3rd to the 12th. Results are interpreted under the light of the sen- sitivity of the relation between symptomatic improvement and therapeutic relationship to the client’s collaborative attitude. With depressive patients, particularly difficult regarding the establishment of a collaborative relationship, the quality of the therapeutic bond is less predictive of improvement than with anxious patients (AU)

Este estudio se centró en los aspectos diferenciales de proceso y resultado psicoterapéutico en casos de pacientes que formulan demandas por problemas de ansiedad por una parte y de depresión por otra. La muestra del estudio fue de 103 clientes, 41 del grupo de depresión y 62 del grupo de ansiedad. Se utilizaron como instrumentos para evaluar la alianza terapéutica el cuestionario de evaluación sintomática CORE Outcome Measure y la versión reducida del WAI (Working Alliance Inventory). El objetivo del estudio fue analizar las diferencias entre los dos grupos en cuanto a la alianza terapéutica, las rupturas de la relación terapéutica, los abandonos del tratamiento y las características del vínculo creado entre terapeuta y cliente. Los resultados no indicaron diferencias significativas entre ambos grupos en la gravedad inicial de la demanda, la mejora sintomática diferencial para ninguno de los factores, la correlación entre alianza terapéutica y síntomas en el caso del grupo de depresión, la alianza terapéutica diferencial en las primeras 12 sesiones ni en general ni para ninguno de los factores, y los debilitamientos temporales de la alianza terapéutica ni a los empeoramientos sintomáticos temporales. Sin embargo, en el caso del grupo de ansiedad la correlación entre alianza terapéutica y síntomas era estadísticamente significativa en todas las sesiones desde la 3 a la 12. Los resultados se interpretan a la luz de la sensibilidad de la relación entre mejora sintomática y relación terapéutica en función de las dificultades de colaboración del paciente. Con los pacientes depresivos, especialmente difíciles en cuanto al establecimiento de una relación de colaboración, la calidad del vínculo terapéutico es menos predictora de la mejora que con los pacientes ansiosos (AU)

Predictors of therapeutic outcome and process.

This article presents an intensive study of the outcome and process of the psychotherapeutic treatments conducted at the Blanquerna Psychotherapy Service in Barcelona. It analyzes in detail the relation between outcome (improvement) and process (therapeutic alliance). Specifically, it discusses (a) the therapeutic process in terms of the relation between therapeutic alliance and psychotherapy outcome and (b) the effects of the temporary weakening of the therapeutic alliance and temporary symptomatic relapse on therapeutic outcome and process. Two hundred thirty-nine clients were included in the study, and the assessment instruments were the CORE Outcome Measure and the short version of the Working Alliance Inventory. In addition to good outcome of psychotherapy and maintenance of therapeutic change after treatment, the results also demonstrated the significance of different aspects of the therapeutic alliance as predictors of the therapeutic outcome and process.

Impact of defense style on brief psychotherapy of postpartum depression.

In this study, we evaluated the impact of defense style (DS) on outcome and its relation to the therapeutic alliance. Women with postpartum depression were allocated to a brief psychotherapeutic intervention. To evaluate DS and the therapeutic alliance, the Defense Style Questionnaire and the Working Alliance Inventory were employed. The main outcome was the Edinburgh Postnatal Depression Scale score at end point; anxiety and retention in treatment were also evaluated. Fifty-nine patients were included; 46 completed the therapy and 65.4% responded (Edinburgh Postnatal Depression Scale score <10). Intense use of immature defenses was related to persistence of depression and anxiety symptoms at end point, even when controlled for potential confounders. Results tended to confirm a hierarchy of DSs independently of the alliance. Clinicians should be aware of possible differential responses to brief psychotherapies related to DS.

Oxime palladacycles revisited: stone-stable complexes nonetheless very active catalysts.

Our review critically presents the main achievements, advantages, and limitations of oxime palladacycles as high-turnover catalysts for Heck, as well as homo- and cross-coupling reactions such as Suzuki-Miyaura, Stille, Ullmann-type, Cassar-Heck-Sonogashira, sila-Sonogashira, Glaser-type, Hiyama, and alkoxycarbonylation reactions. New developments in this area are reviewed from a mechanistic and synthetic point of view. The role of oxime palladacycles as a source of highly active zero-valent palladium species is also discussed.

Mono- and beta,beta-double-Heck reactions of alpha,beta-unsaturated carbonyl compounds in aqueous media.

Optimized reaction conditions for the mono- and beta,beta-diarylation of electron-deficient alkenes in aqueous media catalyzed either by a p-hydroxyacetophenone oxime-derived palladacycle or by palladium(II) acetate under phosphine-free conditions and in the presence of (dicyclohexyl)methylamine as base are described. Regioselective monoarylation of unsubstituted and substituted alpha,beta-unsaturated carbonyl compounds takes place with aryl iodides at 120 degrees C in water. Aqueous N,N-dimethylacetamide (DMA), tetra-n-butylammonium bromide (TBAB) as additive, and the palladacycle as catalyst are the most efficient conditions for the coupling with aryl bromides, good stereoselectivities being also obtained in the arylation of crotonates and itaconates, whereas cinnamic derivatives afford lower steroselectivity, with the exception of cinnamic acid and nitrile. beta,beta-Diarylation of unsubstituted alpha,beta-unsaturated carbonyl compounds can be controlled by using higher loading of the palladacycle and can be performed in refluxing water for aryl iodides, whereas DMA must be used for aryl bromides. Microwave irradiation can be used in the monoarylation of tert-butyl acrylate with aryl iodides in water or the coupling between ethyl cinnamate and aryl bromides in aqueous DMA.

Psychometric properties of the Spanish version of the Working Alliance Theory of Change Inventory (WATOCI) / Características psicométricas de la versión española del inventario de la alianza terapéutica y teoría del cambio

This Brief Report presents a study of the psychometric qualities of the Working Alliance Theory of Change Inventory (Spanish version). WATOCI’s reliability coefficient based on the internal consistency is good. Results seem to suggest (a) that the theoretical structure of the instrument should be further refined, and (b) that therapeutic alliance may be a more unified construct than is usually thought of. While it is theoretically possible to divide it into different components, clinical research with psychotherapy patients seems to indicate that goals, tasks, bond and theory of change are closely related (AU)

Este artículo presenta un estudio de las características psicométricas de la versión española del Inventario de Alianza Terapéutica y Teoría del Cambio (WATOCI). La estimación del coeficiente de fiabilidad basada en la consistencia interna de la versión española del WATOCI se demostró buena. Los resultados parecen sugerir: (a) que la estructura teorica del instrumento debe ser revisada y refinada a fondo, y (b) que la alianza terapéutica puede ser un constructo más unificado. Teóricamente es posible diferenciar entre las subescalas de la alianza terapéutica, pero los datos indican que los ítems de las subescalas de objetivos, tareas, vínculo positivo y teoría del cambio están muy asociados (AU)

La alianza terapéutica: historia, investigación y evaluación / Therapeutic alliance: history, research and assessment

La psicoterapia no se puede concebir al margen del establecimiento de una relación interpersonal entre cliente y terapeuta. Entre los componentes de la relación terapéutica, la alianza es el que ha recibido más atención por parte de la investigación. En este artículo se describen brevemente algunas de las aportaciones más significativas de las principales orientaciones teóricas en cuanto a la visión de la alianza terapéutica y se revisan las investigaciones principales que han tenido a la alianza como protagonista. La relación significativa entre la alianza terapéutica y los resultados de la terapia así como la interacción entre terapeuta y paciente como variable influyente en el desarrollo de la alianza son algunos de los aspectos que se destacan (AU)

Measuring coping style and resistance among Spanish and Argentine samples: development of the Systematic Treatment Selection Self-Report in Spanish.

This article reports the reliability and validity of the Coping Style and Resistance subscales of the Systematic Treatment Selection Self-Report (STS-SR) scale after its translation to Spanish. The English versions of the STS system identify eight empirically derived patient variables that have been found to moderate the effects of various classes of mental health treatment procedures. Research on these dimensions as treatment indicators, as assessed both by clinicians and through patient self-reports, indicates that they increase the efficiency and effectiveness of treatment among English-speaking samples. This article reports a study of the convergent and discriminant validity of two of the subscales, Coping Style and Trait Resistance. The subscales were translated English into Spanish and administered to large Spanish and Argentine subject pools, along with established measures of the same and related constructs. Results revealed that both scales possessed good internal consistency and adequate discriminant validity. The implications of these findings are discussed.

Constructivismo y construccionismo en terapia familiar: Pragmática, semántica y retórica / Constructivism and constructionism in family therapy: Pragmatic, semantics and rhetoric

Este artículo presenta una visión constructivista/construccionista de la terapia familiar, desde un enfoque centrado en las dimensiones narrativas y retóricas de la interacción. Después de trazar una breve historia del surgimiento del movimiento constructivista en el seno de la terapia familiar sistémica, el artículo presenta una concepción de los sistemas humanos como comunidades de interlocutores activamente implicados en la atribución de significado a la experiencia. El significado se equipara a la inteligibilidad, y se destaca la dimensión narrativa de los problemas humanos que conducen a la terapia. La psicoterapia se define como una empresa de co-construcción narrativa en la que tras la elicitación de las narrativas dominantes...

Constructivismo y construccionismo en terapia familiar: Pragmática, semántica y retórica / Constructivism and constructionism in family therapy: Pragmatic, semantics and rhetoric

Este artículo presenta una visión constructivista/construccionista de la terapia familiar, desde un enfoque centrado en las dimensiones narrativas y retóricas de la interacción. Después de trazar una breve historia del surgimiento del movimiento constructivista en el seno de la terapia familiar sistémica, el artículo presenta una concepción de los sistemas humanos como comunidades de interlocutores activamente implicados en la atribución de significado a la experiencia. El significado se equipara a la inteligibilidad, y se destaca la dimensión narrativa de los problemas humanos que conducen a la terapia. La psicoterapia se define como una empresa de co-construcción narrativa en la que tras la elicitación de las narrativas dominantes...(AU)