Análise de contingências de orientações e auto-orientações em intervencoes clinicas comportamentais

RESUMO

Ha debates sobre quais sao os mecanismos responsaveis por mudancas ocorridas em psicoterapias. Pergunta-se se sao as tecnicas especificas ou as variaveis da relacao terapeutica que propiciam os efeitos da terapia. Tambem tem sido questionado se mudancas comportamentais produzidas pela terapia sao modeladas por contingencias da relacao terapeutica ou sao governadas por novas regras produzidas na terapia. Nas pesquisas sobre emissao de regras (orientacao) e autorregras (auto-orientacao) anteriores a esta pesquisa nao foram encontradas variaveis responsaveis por sua emissao. A determinacao da utilizacao da estrategia de orientacao ora parecia ser o cliente, ora o terapeuta, ora nenhum deles, ora o tema abordado, e possivelmente uma complexa combinacao destas e de outras variaveis. O estudo detalhado das orientacoes e auto-orientacoes de 81 sessoes de terapia analitico-comportamental foi realizado nesta pesquisa com o objetivo de verificar quais as variaveis responsaveis pela emissao de orientacao e auto-orientacao em intervencoes clinicas comportamentais. Os resultados indicaram que a maioria dos terapeutas emitiu de 40 a 60 orientacoes nas nove sessoes analisadas. Os clientes dos terapeutas independente da experiencia apresentaram poucas auto-orientacoes. O numero de orientacoes diminuiu para menos da metade quando se contaram apenas orientacoes com conteudos e funcoes diferentes, indicando que os terapeutas tendem a 'repetir' funcionalmente a orientacao. Para as auto-orientacoes houve diminuicao de um quarto ao se contarem aquelas com conteudo e funcao diferente. O conjunto de terapeutas emitiu mais orientacoes para acao especifica e generica; e de forma similar os clientes estes terapeutas emitiram mais auto- orientacoes para acao especifica e auto-orientacoes para acao generica. (...)

ABSTRACT

Mechanisms responsible for changes that occur in psychotherapy are subject to debate. The question is whether specific techniques or variables of the therapeutic relationship promote the effects of the therapy. Another question is whether behavioral changes produced by therapy are shaped by contingencies of the therapeutic relationship or if they are governed by new rules produced in therapy. In researches about emission of rules (orientation) and self emitted rules (self-orientation) prior to this research, no variables responsible for their emission were found. The use of the orientation strategy seemed to be determined either by the client, or by the therapist, sometimes by neither, and at times by the theme, and possibly by a complex combination of these and other variables. A detailed study of orientations and self-orientations in 81 sessions of behavior analytic therapy was carried out in this research to ascertain which variables were responsible for the emission of orientation and self-orientation in behavioral clinical interventions. The findings indicated that each therapist issued an average of 40to 60 orientations during their nine sessions. The clients of both experienced and inexperienced therapists presented few self-orientations. The number of orientations decreased to less than half when only rules with different contents and functions were counted, indicating that therapists tend to functionally 'repeat' the rule. The self-orientations decreased one quarter when those with different content and function were considered. The group of therapists issued more orientations for specific and generic action; similarly, the clients of these therapists issued more self-orientations for specific and generic action. Episodes of orientation/self-orientation were identified in the 81 sessions, occupying an average of one third of the sessions of experienced therapists, and one quarter of the sessions of inexperienced therapists. (...)