Contrasting Cases in Two Psychotherapeutic Processes Based on Integrative Behavior Couple Therapy / Contraste de casos en dos procesos psicoterapéuticos basados en la terapia de pareja conductual integradora

The present study proposes an evaluation of the therapeutic process in relation to the follow-ing aspects: the therapist adherence, the items which are more and less characteristic in the treatment and the interaction structures, along the therapeutic process of two cases of couple therapy,one with significant positive clinical change and one with significant negative clinical change, in the couple's evaluation. This work used Integrative Behavioral Couple Therapy mod-el, one of the approaches of the third wave therapies.The method was a study of contrasting cases. The similarities and differences between the cases were discussed, reaching the conclu-sion that there are aspects of the couple, the therapist, the therapeutic relationship and the context that may have contributed to the different outcomes. (AU)

El presente estudio propone una evaluación del proceso terapéutico en relación con los siguientes aspectos: la adherencia del terapeuta, los ítems más y menos característicos en el tratamiento y las estructuras de interacción, a lo largo del proceso terapéutico de dos casos de terapia de pareja, uno con cambio clínico positivo significativo y otro con cambio clínico negativo significativo, en la evaluación de la pareja. En este trabajo se utilizó el modelo de Terapia de Pareja Conductual Integrativa, uno de los enfoques de las terapias de tercera ola. El método fue un estudio de casos contrastados. Se discutieron las similitudes y diferencias entre los casos, llegando a la conclusión de que hay aspectos de la pareja, del terapeuta, de la relación terapéutica y del contexto que pueden haber contribuido a los diferentes resultados. (AU)

Terapia on-line com casais e famílias: prática e formação na pandemia de covid-19 / Online therapy with couples and families: practice and training in the covid-19 pandemic / Terapia de parejas y familias on line: práctica y formación en la pandemia de covid-19

Resumo A pandemia de Covid-19 potencializou o já emergente processo de intensificação das conexões virtuais. Para terapeutas de casal e família, essa grave crise de saúde pública acarretou mudanças na forma de atender clientes e interagir com colegas, exigindo a rápida transição da modalidade presencial para a modalidade remota, em muitos casos. O presente estudo sistematizou conhecimentos sobre terapia on-line com casais e famílias, trazendo considerações para a prática e a formação profissional diante da pandemia. Por meio de revisão narrativa da literatura, foram sumarizados resultados de estudos empíricos, bem como recomendações sobre aspectos técnicos, éticos e formativos. Destacaram-se, em particular, potencialidades e desafios para a utilização de tecnologias da informação e da comunicação na prática clínica com casais e famílias, incluindo indicações e contraindicações, recursos mais apropriados e seguros, relação terapêutica on-line, capacitação e supervisão. Entende-se que a Covid-19 representa uma oportunidade para revisão e reflexão da prática clínica e da formação profissional de terapeutas de casal e família no Brasil, país em que as intervenções on-line permaneciam relativamente pouco exploradas até a pandemia.

Abstract The Covid-19 pandemic has boosted the already emerging process of virtual connections. For couple and family therapists, this major public health crisis has led to changes in the way of treating clients and interacting with colleagues, requiring rapid transition from face-to-face to remote mode, in many cases. This study systematized knowledge about online therapy with couples and families, bringing considerations for practice and professional training in the face of the pandemic. By conducting a narrative literature review, we summarized results from empirical studies, as well as recommendations on technical, ethical, and formative aspects. Specifically, we highlighted both the potential and the challenges of using information and communication technologies in clinical practice with couples and families, including indications and contraindications, more appropriate and safer resources, online therapeutic relationship, training, and supervision. Covid-19 represents an opportunity for reviewing and analyzing the clinical practice and professional training of couples and family therapists in Brazil, a country in which online interventions remained relatively little explored until the pandemic.

Resumen La pandemia de Covid-19 potenció el proceso ya emergente de conexiones virtuales. Para terapeutas de parejas y familias, esa grave emergencia de salud pública acarreó cambios en la forma de atender a clientes e interactuar con colegas, exigiendo la rápida transición de la modalidad presencial para la modalidad remota, en muchos casos. El presente estudio sistematizó conocimientos sobre terapia de parejas y familias on line, trayendo consideraciones para la práctica y la formación profesional en la pandemia. Por medio de revisión narrativa de la literatura, fueron obtenidos resultados de estudios empíricos, así como recomendaciones sobre aspectos técnicos, éticos y formativos. Se destacaron, en particular, potencialidades y desafíos para usar tecnologías de la información y de la comunicación en la práctica clínica con parejas y familias, incluyendo indicaciones y contraindicaciones, recursos más apropiados y seguros, relación terapéutica on line, capacitación y supervisión. Se entiende que el Covid-19 representa una oportunidad para la revisión y reflexión de la práctica clínica y de la formación profesional de terapeutas de parejas y familias en Brasil, donde las intervenciones on line permanecían relativamente poco exploradas hasta la pandemia.

What Does it Mean to be a Common Factors Informed Family Therapist?

The common factors paradigm in couple and family therapy has gained popularity over the past several decades, leading many therapists to refer to themselves as common factors family therapists. Despite this, no consensus exists on what it means to be a common factors family therapist, or if such a designation even makes sense given that the common factors paradigm is not a model. Synthesizing the existing common factors literature, a case is made for the designation "common factors informed family therapist," and the following six core principles are outlined that characterize this designation: (1) sees overlap among theories; (2) passionate about theory, not a theory; (3) client centered; (4) monitors hope and the therapeutic alliance; (5) views clients as people rather than objects; and (6) prioritizes healing over therapy. Each of the concepts is discussed in depth, and clinical implications are provided.

El paradigma de factores comunes en la terapia de parejas y familiar ha cobrado popularidad en las últimas décadas, haciendo que muchos terapeutas se refieran a sí mismos como terapeutas de factores comunes. A pesar de esto, no hay un consenso acerca de qué significa ser un terapeuta de factores comunes, o si dicha designación realmente tiene sentido, dado que el paradigma de factores comunes no es un modelo. A base de una síntesis de la literatura de factores comunes existente, se aboga por la designación "terapeuta familiar informado por factores comunes", y se esbozan seis principios fundamentales que caracterizan esta designación; 1) ve que las teorías se entrecruzan; 2) apasionado por lo teórico, no por una teoría; 3) centrado en los clientes; 4) está pendiente de la esperanza y la alianza terapéutica; 5) ve a los clientes como personas en vez de objetos; y 6) se preocupa más por la sanación que por la terapia. Se discute cada concepto a profundidad y se proporcionan las implicaciones clínicas.

Unequally into "Us": Characteristics of Individuals in Asymmetrically Committed Relationships.

This study examined characteristics of individuals that are associated with being in asymmetrically committed relationships (ACRs), defined as romantic relationships in which there was a substantial difference in the commitment levels of the partners. These ACRs were studied in a national sample of unmarried, opposite-sex romantic relationships (N = 315 couples). Perceiving oneself as having more potential alternative partners was associated with increased odds of being the less committed partner in an ACR compared to not being in an ACR, as was being more attachment avoidant, having more prior relationship partners, and having a history of extradyadic sex during the present relationship. Additionally, having parents who never married was associated with being the less committed partner in an ACR but parental divorce was not. Although fewer characteristics were associated with being the more committed partner within an ACR, more attachment anxiety was associated with increased odds of being in such a position compared to not being in an ACR. We also address how some findings change when controlling for commitment levels. Overall, the findings advance understanding of commitment in romantic relationships, particularly when there are substantial asymmetries involved. Implications for both research on asymmetrical commitment as well as practice (e.g., therapy or relationship education) are discussed.

Este estudio examinó características de individuos que se encuentran en relaciones comprometidas asimétricamente (RCA), definidas como relaciones románticas en las que hay una diferencia significativa en los niveles de compromiso de cada pareja. Estas RCA fueron estudiadas en una muestra nacional de relaciones románticas solteras con el sexo opuesto (N = 315 parejas). La autopercepción de tener más alternativas posibles de parejas se asoció a una probabilidad mayor de ser la pareja menos comprometida en una RCA en comparación con no estar en una RCA, así como de evitar más los apegos, tener más parejas previas, y tener un historial de sexo extradiádico durante la relación actual. Además, tener padres que nunca se casaron se asoció a ser la pareja menos comprometida en una RCA, pero no así el divorcio de los padres. Aunque se asociaron menos características a ser la pareja más comprometida en una RCA, se asoció más ansiedad de apego a una probabilidad mayor de encontrarse en dicha posición en comparación con no estar en una RCA. También abordamos el tema de cómo cambian algunos hallazgos al controlar niveles de compromiso. En conjunto, los hallazgos avanzan el entendimiento del compromiso en relaciones románticas, especialmente cuando incluye asimetrías significativas. Se discuten las implicaciones tanto para la investigación del compromiso asimétrico así como la práctica (p.ej. terapia o educación de relaciones).

Dyadic Coping in Couple Therapy Process: An Exploratory Study.

This study aimed at moving beyond previous research on couple therapy efficacy by examining moment-by-moment proximal couple and therapist interactions as well as final treatment outcomes and their reciprocal association. Seven hundred four episodes of dyadic coping within 56 early therapy sessions, taken from 28 married couples in treatment, were intensively analyzed and processed using a mixed-methods software (T-LAB). Results showed that negative dyadic coping was self-perpetuating, and therapists tended to passively observe the negative couple interaction; on the contrary, positive dyadic coping appeared to require a therapist's intervention to be maintained, and successful interventions mainly included information gathering as well as interpreting. Couples who dropped out of treatment were not actively engaged from the outset of therapy, and they used more negative dyadic coping, whereas couples who successfully completed treatment showed more positive dyadic coping very early in therapy. Results highlight the role of therapist action and control as critical to establishing rapport and credibility in couple therapy and suggest that dyadic coping patterns early in therapy may contribute to variable treatment response.

Partner Pronoun Use, Communal Coping, and Abstinence during Couple-Focused Intervention for Problematic Alcohol Use.

Communal coping-a process in which romantic partners view a problem as ours rather than yours or mine, and take collaborative action to address it -has emerged as an important predictor of health and treatment outcomes. In a study of partners' pronoun use prior to and during couple-focused alcohol interventions, we examined first-person plural (we-talk) and singular (I-talk) pronouns as linguistic markers of communal coping and behavioral predictors of treatment outcome. Thirty-three couples in which one partner abused alcohol were selected from a randomized control trial (N = 63) of couple-focused Cognitive-Behavioral or Family Systems Therapy if they had unambiguously successful or unsuccessful treatment outcomes (i.e., patient maintained abstinence for 30 days prior to treatment termination or had more than one heavy drinking day in the same period). Pronoun measures for each partner were obtained via computerized text analysis from transcripts of partners' speech, derived from a videotaped pretreatment interaction task and three subsequent therapy sessions. Spouse we-talk during the intervention (accounting for pretreatment we-talk), as an index of communal orientation, uniquely predicted successful treatment outcomes. In contrast, both patient and spouse I-talk during the intervention (accounting for pretreatment I-talk), as a marker of individualistic orientation, uniquely predicted unsuccessful outcomes, especially when distinguishing active and passive (I vs. me/my) pronoun forms. Results strengthen evidence for the prognostic significance of spouse behavior for patient health outcomes and for communal coping (indexed via pronoun use) as a potential mechanism of change in couple-focused interventions for health problems.

Um estudo de follow up em psicoterapia psicanalítica de casais / A follow up study concerning psychoanalytical psychotherapy of couples / Un estudio del follow up en psicoterapia psicoanalítica de parejas

Por 11 anos desenvolvemos uma pesquisa envolvendo uma proposta interventiva com famílias que buscam atendimento em um serviço-escola, com demanda localizada na criança. Por meio da psicoterapia psicanalítica com o casal procuramos atingir a remissão dos sintomas do(s) filho(s). O objetivo deste estudo é refletir sobre a manutenção das mudanças psíquicas ocorridas nesse tipo de clínica, que abrange a esfera conjugal e familiar, ao longo do tempo. Com base na metodologia de estudo de caso e no referencial psicanalítico, foram analisados dois casos clínicos enfatizando-se as sessões de follow up: dois casais que estiveram em processo terapêutico, respectivamente, por três anos e por dois anos e meio, sendo realizadas duas sessões de acompanhamento após o término da terapia. Esse tipo de intervenção mostrou-se efetiva para a elucidação de conflitos conjugais latentes e como promovedora de um ambiente saudável e favorecedor do desenvolvimento emocional da criança.

For eleven years we have been conducting a research that consists in a proposal of intervention with families that look for therapy for a child. Through the psychoanalytical psychotherapy of couples, we try to release the child's symptoms. The aim of this article is to reflect about the maintenance over time of the psychic changes obtained in this clinical practice, which evolves conjugal and familiar levels. Making use of the case study methodology and the psychoanalytic theory, two clinical cases were analyzed, with emphasis in follow up sessions: two couples that had been in therapy for 3 years and 2,5 years, and each couple has participated in two follow up interviews after the end of the therapy. This intervention showed up to be effective on the elucidation of latent conjugal conflicts and also as a promoter of a healthy and supportive environment in the emotional development of the child.

Hace once años hemos desarrollado una investigación que consiste en una propuesta de intervención en familias que buscan atención con una demanda localizada en los niños. Por medio de la psicoterapia psicoanalítica con la pareja, intentamos alcanzar la remisión de los síntomas de lo(s) hijo(s). El objetivo de este artículo es reflexionar sobre la manutención de los cambios psíquicos ocurridos en ese tipo de clínica, que abarca la esfera conyugal y familiar, a lo largo del tiempo. A partir de la metodología del estudio de caso y del referencial psicoanalítico, dos casos clínicos fueron analizados, enfatizándose las sesiones de "follow up": dos parejas asistidas en psicoterapia, por 3 y 2,5 años, con los cuales se realizaron dos sesiones de acompañamiento después del término de la psicoterapia. Ese tipo de intervención fue efectivo en la detección de los conflictos conyugales latentes, proporcionando un ambiente favorecedor del desarrollo emocional del niño.

Um estudo de follow up em psicoterapia psicanalítica de casais / A follow up study concerning psychoanalytical psychotherapy of couples / Un estudio del follow up en psicoterapia psicoanalítica de parejas

Por 11 anos desenvolvemos uma pesquisa envolvendo uma proposta interventiva com famílias que buscam atendimento em um serviço-escola, com demanda localizada na criança. Por meio da psicoterapia psicanalítica com o casal procuramos atingir a remissão dos sintomas do(s) filho(s). O objetivo deste estudo é refletir sobre a manutenção das mudanças psíquicas ocorridas nesse tipo de clínica, que abrange a esfera conjugal e familiar, ao longo do tempo. Com base na metodologia de estudo de caso e no referencial psicanalítico, foram analisados dois casos clínicos enfatizando-se as sessões de follow up: dois casais que estiveram em processo terapêutico, respectivamente, por três anos e por dois anos e meio, sendo realizadas duas sessões de acompanhamento após o término da terapia. Esse tipo de intervenção mostrou-se efetiva para a elucidação de conflitos conjugais latentes e como promovedora de um ambiente saudável e favorecedor do desenvolvimento emocional da criança.(AU)

For eleven years we have been conducting a research that consists in a proposal of intervention with families that look for therapy for a child. Through the psychoanalytical psychotherapy of couples, we try to release the child's symptoms. The aim of this article is to reflect about the maintenance over time of the psychic changes obtained in this clinical practice, which evolves conjugal and familiar levels. Making use of the case study methodology and the psychoanalytic theory, two clinical cases were analyzed, with emphasis in follow up sessions: two couples that had been in therapy for 3 years and 2,5 years, and each couple has participated in two follow up interviews after the end of the therapy. This intervention showed up to be effective on the elucidation of latent conjugal conflicts and also as a promoter of a healthy and supportive environment in the emotional development of the child.(AU)

Hace once años hemos desarrollado una investigación que consiste en una propuesta de intervención en familias que buscan atención con una demanda localizada en los niños. Por medio de la psicoterapia psicoanalítica con la pareja, intentamos alcanzar la remisión de los síntomas de lo(s) hijo(s). El objetivo de este artículo es reflexionar sobre la manutención de los cambios psíquicos ocurridos en ese tipo de clínica, que abarca la esfera conyugal y familiar, a lo largo del tiempo. A partir de la metodología del estudio de caso y del referencial psicoanalítico, dos casos clínicos fueron analizados, enfatizándose las sesiones de "follow up": dos parejas asistidas en psicoterapia, por 3 y 2,5 años, con los cuales se realizaron dos sesiones de acompañamiento después del término de la psicoterapia. Ese tipo de intervención fue efectivo en la detección de los conflictos conyugales latentes, proporcionando un ambiente favorecedor del desarrollo emocional del niño.(AU)