Differences in the Communication of Cancer Diagnoses by Different Health Professionals and the Impact of Oncologist Communication on Patients' Emotions.

The field of healthcare is increasingly adopting a humanistic perspective in the physician-patient relationship. One of the more salient aspects being studied is the communication between the two. This study serves a dual purpose. Our initial aim was to study how a cancer diagnosis is disclosed to patients by different physicians (GPs/other specialists/oncologists). Secondly, we set out to study how the way in which oncologists normally communicate with their patients impacts variables such as a patient's anxiety, depression, coping mechanisms, and perception of both their health and their quality of life. A total of 177 patients answered a battery of questionnaires on sociodemographic and disease data: the SPIKES protocol, the EORTCQLQ-COMU26, and the ADAF screening questionnaire. The analyses recorded medium or high scores for some of the steps in the SPIKES protocol when delivering the diagnosis, and significant differences were observed for some of them among different physicians. The level of a cancer patient's satisfaction with the communication by oncologists was related to their levels of anxiety, depression, vulnerability, and perception of their health and quality of life. Better communication strategies are called for among all healthcare professionals to facilitate the task of breaking bad news to their patients.

A theoretical and methodological proposal for the descriptive assessment of therapeutic interactions.

OBJECTIVE: The goal of this study is to show the development of a strategy for a descriptive assessment of the therapeutic interaction. METHOD: In this study, we develop an observational methodology to analyze the dialogues that took place during 92 sessions conducted in a psychological center in Madrid, Spain, in which 19 adults were treated for various psychological problems by 9 behavioral therapists. A system was developed to codify vocal behavior of both the therapists and the clients; the software The Observer XT was used for recording. Therapeutic interactions were analyzed using sequential analysis. RESULTS: There are three main sequences that synthesize the therapist-client interaction: first, an utterance by the client preceded by a therapist's verbalization, specifically a question (discriminative morphology) and followed by an expression of approval (reinforcement morphology); second, verbalizations of failure or discomfort uttered by the client, followed most often by verbalizations of disapproval (punishing morphology) uttered by the therapist; and third, verbalizations uttered by the client that are discriminated by the therapist after an in-depth explanation and followed by different therapist's utterances (expressions of approval, technical information, etc.). CONCLUSIONS: Depending on how the client responds the results in this study present a starting point for the study of the functional sequences that form the basis of therapeutic change.

Verbal interaction patterns in the clinical context: a model of how people change in therapy.

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.

Verbal interaction patterns in the clinical context: A model of how people change in therapy / Patrones de interacción verbal en el contexto clínico: un modelo de cómo la gente cambia en terapia

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

Análisis de la conducta verbal del cliente durante el proceso terapéutico / Analysis of the client's verbal behavior during the therapeutic process

En el presente trabajo llevamos a cabo un análisis del cliente centrándonos en la actividad principal que se desempeña en sesión: hablar. Utilizando metodología observacional realizamos un estudio topográfico de la conducta verbal de los clientes a través del desarrollo de un instrumento de medida generado por el grupo de investigación: el Sistema de Categorización de la Conducta Verbal del Cliente (SISC- CVC). Se observaron y registraron 92 sesiones terapéuticas procedentes de 19 casos tratados por 9 terapeutas distintos. Los resultados muestran que, en líneas generales, el cliente principalmente ofrece información descriptiva relevante para la terapia, muestra su aceptación y entendimiento ante verbalizaciones del terapeuta cuya finalidad sea informar, motivar o instruir y expresa en mucha mayor medida contenidos relacionados con el cambio clínico frente a contenidos alejados de los objetivos perseguidos. Podemos concluir, además, que la conducta verbal de los clientes varía en función de la actividad terapéutica que se esté llevando a cabo y es independiente de la problemática tratada, las características personales del cliente o el estilo terapéutico del clínico (AU)

In this paper we conduct an analysis of the client behavior focusing on the main activity that is performed in session: talking. Using observational methodology we performed a topographical study of clients’ verbal behavior through the development of a measuring instrument by our research group: Categorization system of the interaction of client´s verbal behavior during the session (SISC- CVC). 92 clinical sessions from 19 cases treated by 9 therapists were observed and recorded. The results show that, in general, the client mainly provides descriptive information relevant to therapy, shows acceptance and understanding to the therapist’s verbalizations aiming to inform, motivate or instruct, and expresses more frequently contents related to clinical change compared to contents opposed to the objectives pursued. We can also conclude that the clients’ verbal behavior varies depending on the therapeutic activity that is taking place and is independent of the problems treated, the personal characteristics of the client or the clinician's therapeutic style (AU)

Descriptive study of the Socratic method: evidence for verbal shaping.

In this study we analyzed 65 fragments of session recordings in which a cognitive behavioral therapist employed the Socratic method with her patients. Specialized coding instruments were used to categorize the verbal behavior of the psychologist and the patients. First the fragments were classified as more or less successful depending on the overall degree of concordance between the patient's verbal behavior and the therapeutic objectives. Then the fragments were submitted to sequential analysis so as to discover regularities linking the patient's verbal behavior and the therapist's responses to it. Important differences between the more and the less successful fragments involved the therapist's approval or disapproval of verbalizations that approximated therapeutic goals. These approvals and disapprovals were associated with increases and decreases, respectively, in the patient's behavior. These results are consistent with the existence, in this particular case, of a process of shaping through which the therapist modifies the patient's verbal behavior in the overall direction of his or her chosen therapeutic objectives.

Functional analysis of the verbal interaction between psychologist and client during the therapeutic process.

The goal of this study is to analyze the verbal interaction that takes place between client and therapist over the course of a clinical intervention so as to analyze the potential learning processes that may be responsible for changes in the client's behavior. A total of 92 sessions were analyzed, corresponding to 19 clinical cases treated by 9 therapists specializing in behavioral therapy. The variables considered were therapist and client verbal behaviors, and these were categorized according to their possible functions and/or morphologies. The Observer XT software was used as a tool for the observational analysis. The results led to the conclusion that the therapist responds differentially to client verbalizations, modifying the verbal contingencies as his or her client content approaches or becomes more distant from therapeutic objectives. These results suggest the possible existence of verbal "shaping" processes through which the therapist guides the client's verbal behavior toward more adaptive forms. In addition, this study proposes an alternative to the traditional controversy regarding the relevance of the therapeutic relationship versus the treatment techniques used to explain clinical change. This article suggests that such differentiation is unnecessary because the therapeutic relationship and the treatment techniques should act in the same manner, this is, in providing the context for the occurrence of what is truly therapeutic, namely, the learning processes.

Estudio comparativo de la conducta verbal del terapeuta según su experiencia durante la evaluación clínica / Comparative study of therapist’s verbal behavior according its experience during clinical assessment

En el presente trabajo se ha realizado una primera aproximación al estudio de las diferencias entre terapeutas con diversos grados de experiencia. La lógica de este tipo de trabajos se centra en el supuesto de que el terapeuta experto es el que lo hace bien y analizar su comportamiento nos permitirá aprender cómo hacer terapia más eficientemente. La metodología de trabajo empleada es la observación y análisis de sesiones terapéuticas grabadas directamente y registradas mediante un sistema de categorías construido a tal efecto. Los resultados muestran que las categorías Función Discriminativa, Función de Refuerzo y Otras son las más utilizadas por los terapeutas inexpertos mientras que las categorías Función de Castigo, Función Evocadora, Función Motivadora, Función Instruccional y Función Informativa son las más usadas por expertos, observándose en la mayoría de los casos valores intermedios en los terapeutas de mediana experiencia. A pesar de las limitaciones encontradas, estos resultados indican que pueden existir diferencias tanto cuantitativas como cualitativas respecto a lo que hacen los terapeutas en sesión en función de su grado de experiencia (AU)

The present study is an initial approach to the study of differences between therapists with regard to their experience level. This type of study is based on the assumption that it is the expert therapist who does things well, and that the analysis of his/her behaviour will enable us to learn how to do therapy more efficiently. We used an observational methodology for the analysis of video-taped sessions. Verbal behaviour was coded with a coding system created for that purpose. Results show that the Discriminative, Reinforcement and “Others” functions were the most used by inexpert therapists, while Punishment, Elicitation, Motivating, Instructional, and Informative were the functions most used by expert therapists. Intermediate values were observed for most therapists with a middle degree of experience. Despite certain limitations, results indicate that there may be quantitative, as well as qualitative, differences with respect to what therapists do in session as a function of their experience level (AU)

El Proceso Terapéutico "Momento a Momento" desde una Perspectiva Analítico-Funcional / A "Moment-to-Moment" Analysis of the Therapeutic Process Using a Functional-Analytic Approach

Este trabajo describe cómo se desarrolla el proceso terapéutico en un caso concreto mediante el estudio de las posibles funciones de la conducta verbal del terapeuta durante la interacción con su cliente. Para ello, se procedió a la observación de las grabaciones de las 10 sesiones que constituyeron la totalidad de la intervención terapéutica del caso estudiado. La categorización del comportamiento verbal del psicólogo en sesión fue realizada mediante el software The Observer® XT y la aplicación del Sistema de Categorización de la Conducta Verbal del Terapeuta (SISC-CVT) desarrollado por las autoras y asociado a altos niveles de concordancia inter e intra observadores. El análisis de los registros permitió una primera aproximación a la formulación de una "radiografía funcional" del proceso terapéutico que puede tener importantes implicaciones para el estudio y comprensión del fenómeno clínico así como para el diseño, entrenamiento y aplicación de formas más efectivas de intervención psicológica (AU)

This study analyzes the potential functions of the therapist's verbal behavior during actual in-session therapist-client interactions. The complete therapeutic process of a clinical case was recorded (10 sessions). The therapist's verbal behavior was coded by means of The Observer® XT software and the Therapists' Verbal Behavior Category System (SISC-CVT), which has shown high levels of inter and intra-rater agreement. Results showed a descriptive analysis of the therapeutic process. Our results help to understand the functional relations and learning mechanisms that may be involved during in-session verbal interaction. The approach illustrated in the present study could serve a first step to designing, training and putting into practice more effective psychological interventions (AU)

Aproximación al Estudio Funcional de la Interacción Verbal entre Terapeuta y Cliente Durante el Proceso Terapéutico / An Approach to the Functional Study of the Verbal Interaction Between Therapist and Client During the Therapeutic Process

En este trabajo se presenta el desarrollo de un sistema de categorías de la conducta verbal del terapeuta (SISC-CVT) y su aplicación para el análisis de sesiones de terapia; el objetivo fue identificar topografías del comportamiento verbal de los clínicos que podrían corresponderse con las posibles funcionalidades de tal comportamiento. Se trabajó con 101 sesiones procedentes de 21 casos de adultos tratados por 8 terapeutas. La hipótesis de partida era que las categorías de la conducta verbal de los terapeutas se distribuirían en la intervención clínica de manera que se podría establecer un modelo de actuación verbal relacionado con el objetivo clínico durante el proceso terapéutico. Los resultados de los análisis realizados confirman esta hipótesis y permiten afirmar que lo que se relaciona con el tipo de comportamiento verbal emitido por los terapeutas es la actividad clínicamente relevante que se está llevando a cabo en sesión. Según estos resultados los terapeutas realizan cuatro tipos de actividades clínicamente relevantes (evaluación, explicación, tratamiento y consolidación del cambio) que están relacionadas con el tipo de categorías de la conducta verbal que predomina en cada una de ellas más que con el momento temporal de la terapia en el que tienen lugar (AU)

This paper presents the development process of a coding system of the verbal behavior of therapists (SISC-CVT) and its application in the analysis of a series of clinical sessions. The aim was to identify topographies of the clinicians' verbal behavior that could be related to the hypothesized functions of this behavior. We analyze the recordings of 101 sessions, corresponding to 21 adult clinical cases. The initial hypothesis was that the categories of therapists' verbal behavior are distributed throughout the clinical intervention in such a way that a model of verbal performance could be established related to the clinical objective pursued by the psychologist during the therapeutic process. The results have confirmed this hypothesis and support the conclusion that what is related to the type of verbal behavior emitted by cognitive-behavioral therapists is the clinically relevant activity that is being carried out in session. According to these results, therapists perform four types of clinically relevant activity (assessment, explanation, treatment and consolidation of change). These are related to the type of categories of verbal behavior that are most frequent during each activity, rather than to the temporal moment of therapy in which they occur (AU)

[Therapists' verbal behavior category system]. / Sistema de categorización de la conducta verbal del terapeuta.

This paper presents the theoretical and methodological basis of a therapist's verbal behavior category system that allows us to study clinical psychologists' language from a functional-analytic framework and with a rigorous observation method. The procedure to develop the coding system is explained in detail from a very early stage of exploratory observation, to the systematic observation through the use of The Observer XT software. An analysis of intra- and inter-rater reliability using the kappa coefficient and taking into account the factors that affect the values of Cohen's index was carried out. Results show high levels of observer accuracy (between approximately 87% and 93%) that justify the application of this category system to study therapists' verbal behavior in session.

Sistema de categorización de la conducta verbal del terapeuta / Therapists’ verbal behavior category system

En este trabajo se presentan los fundamentos teóricos y metodológicos para el desarrollo de un sistema de categorización de la conducta verbal del psicólogo clínico durante la intervención terapéutica, que nos permita el estudio de ésta desde una perspectiva analítico-funcional basada en una rigurosa metodología observacional. El procedimiento de construcción de dicho sistema es detallado desde las etapas iniciales de observación exploratoria hasta la observación sistemática de la conducta a analizar con la ayuda del software The Observer XT. Asimismo, se lleva a cabo un estudio del grado de acuerdo inter e intra observadores mediante el cálculo del coeficiente kappa y la consideración de los factores que afectan a los valores de dicho índice. Los resultados del análisis muestran altos niveles de precisión de los observadores (entre un 87 y un 93%, aproximadamente) que justifican la utilización del sistema de categorías elaborado para el estudio del lenguaje de los terapeutas en la clínica

This paper presents the theoretical and methodological basis of a therapist’s verbal behavior category system that allows us to study clinical psychologists’ language from a functional-analytic framework and with a rigorous observation method. The procedure to develop the coding system is explained in detail from a very early stage of exploratory observation, to the systematic observation through the use of The Observer XT software. An analysis of intra- and inter-rater reliability using the kappa coefficient and taking into account the factors that affect the values of Cohen’s index was carried out. Results show high levels of observer accuracy (between approximately 87% and 93%) that justify the application of this category system to study therapists’ verbal behavior in session