Importancia de los cambios iniciales en la psicoterapia con adolescentes / Relevance of early changes in psychotherapy with adolescents

Esta investigación tiene por objetivo estudiar los Indicadores de Cambio Genéricos (ICG) en psicoterapias con adolescentes, realizadas en contexto natural. Específicamente focaliza en la evolución de los ICG al interior de la etapa inicial de la terapia y su relación con la adherencia al tratamiento. Participaron 19 adolescentes, con diferentes diagnósticos, en modalidad de terapia individual de diferentes orientaciones teóricas. Evaluadores entrenados identificaron los ICG en las tres sesiones iniciales. Los resultados indican que se observa una evolución al interior de la etapa inicial de la terapia, en el sentido de un predominio de los indicadores jerárquicamente más bajos en la primera sesión en relación a la segunda y la tercera. Además los ICG máximos alcanzados en la fase inicial permiten predecir en forma significativa la probabilidad de terminar el proceso terapéutico.

This research is focused on the study Generic Change Indicators (GCI) in psychotherapies with adolescents conducted in natural settings. Specifically, it is centered on the evolution of GCI during the initial stage of therapy and their relation with treatment adherence. The participants were 19 adolescents with various diagnoses, who were receiving individual therapy with different theoretical approaches. Trained raters identified the CGI in the three initial sessions. The results reveal an evolution during the initial therapy stage, with hierarchically lower indicators dominating the first session and then decreasing in the second and third. In addition, the maximum CGI reached in the initial phase significantly predict the likelihood of completing the therapeutic process.

Generic change indicators in therapeutic processes with different outcomes.

OBJECTIVES: This paper analyzes the relationship between ongoing change and final outcome in therapies carried out in natural settings with 39 clients. METHOD: Ongoing change was assessed through generic change indicators (GCIs), an observational method designed to label the content of change moments by selecting one specific GCI from the sequence of 19 that covers from more rudimentary and low complexity to more elaborated and complex changes. These GCIs can also be grouped into three broad stages of change, according to their level of complexity. Productivity indicators were generated to account for the number of GCIs (total and grouped by stage) adjusted by the length of therapy and the respective individual production of GCIs. Outcome, in turn, is understood as the final result of therapy and was measured by Lambert's Outcome Questionnaire (OQ 45.2). RESULTS: Using the Reliable Change Index of this measure, which qualifies the difference between initial and final scores, therapies were grouped into "good outcome" and "poor outcome" cases. Findings indicate that therapies with good final outcome show a greater presence of Stage III GCIs during the process. Furthermore, in these therapies there is a significant association between Stage I GCI productivity and the productivity of Stages II and III GCIs. This is not the case for poor outcome cases, where results show a greater productivity of initial stage GCIs, mostly in the second half of therapy and no relation of this productivity with Stage II and Stage III GCIs. CONCLUSIONS: Results support the relation of ongoing change and final outcome. Possibilities for the clinical use of GCIs, specifically for monitoring ongoing therapies, are discussed.