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Relações que resultam: a aliança terapeuta-cliente como base para a intervenção psicodinâmica
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Abstract(s)
A Terapia para as Fobias de Afetos (TFA) é um modelo de Psicoterapia Psicodinâmica Breve (PPB), segundo o qual os sintomas psicopatológicos do cliente são entendidos como resultado de defesas desadaptativas que os indivíduos utilizam para lidar com as emoções que são temidas. Posto isto, a TFA tem como objetivo expôr gradualmente o cliente a uma ativação afetiva segura e à experiência autêntica das suas emoções, de modo a reestruturar as fobias afetivas e melhorar a sintomatologia do sujeito. Para que tal seja possível, o modelo terapêutico atribui particular relevo à importância da aliança terapêutica entre a díade, descrevendo-a como um “pré-requisito” para a intervenção aplicada pelo terapeuta. Contudo, a literatura é relativamente recente no que diz respeito à relevância da aliança terapêutica para o efeito das intervenções psicoterapêuticas, especificamente no modelo da TFA.
O presente estudo visou analisar se os resultados da intervenção terapêutica psicodinâmica, específica ao tratamento da TFA, dependem dos níveis de aliança terapêutica. Para a concretização do mesmo, foi recolhida uma amostra constituída por 31 clientes acompanhados num Serviço de Psicologia universitário e 3 terapeutas responsáveis pelo atendimento psicoterapêutico.
Os clientes responderam ao Inventário de Aliança Terapêutica – Revisto e Reduzido (IAT-RR) e ao Outcome Questionnaire-10 (OQ-10), e os terapeutas responderam à Escala de Aquisição dos Objetivos Terapêuticos (ATOS) - Versão do Terapeuta. Os dados recolhidos foram organizados através de uma estrutura hierárquica e analisados com recurso ao método dos Modelos Lineares Hierárquicos (MLH).
Os resultados obtidos sugerem que a melhoria sintomatológica do cliente ocorre quando níveis elevados de aliança terapêutica e, em particular, do vínculo interagem com as intervenções terapêuticas de promoção do reconhecimento de padrões de defesa desadaptativos, desenvolvimento de sentimentos positivos face ao self e reestruturação da perceção dos outros. Ao contrário do esperado, foi observado que níveis elevados de acordo nas tarefas podem potenciar a sintomatologia, aquando da intervenção para a experiência emocional. Os resultados deste estudo enfatizam a importância de os terapeutas promoverem a aliança, antes de colocarem em prática intervenções terapêuticas psicodinâmicas.
The Therapy for Affect Phobias (TFA) is a model of Brief Psychodynamic Therapy (BPT), according to which the client's psychopathological symptoms are understood as a result of maladaptive defenses that individuals use to deal with feared emotions. That said, TFA aims to gradually expose the client to safe affective activation and the authentic experience of their emotions, to restructure affective phobias and improve the subject's symptomatology. For this to be possible, the therapeutic model attaches particular importance to the importance of the therapeutic alliance between the dyad, describing it as a “prerequisite” for the intervention applied by the therapist. However, the literature is relatively recent regarding the relevance of the therapeutic alliance for the effect of psychotherapeutic interventions, specifically in the AFT model. The present study aimed to analyze whether the results of psychodynamic therapeutic intervention, specific to the treatment of AFT, depend on the levels of therapeutic alliance. For the realization of the same, a sample was collected consisting of 31 clients monitored in a University Psychology Service and 3 therapists responsible for psychotherapeutic care. Clients answered the Working Alliance Inventory - Short Revised (WAI -SR) and the Outcome Questionnaire-10 (OQ-10), and the therapists answered the Achievement of Treatment Objectives Scales (ATOS) - Therapist Version. The collected data was organized using a hierarchical structure and analyzed using the method set by the Hierarchical Linear Modeling (HLM). The obtained results suggest that the client's symptomatic improvement occurs when high levels of therapeutic alliance and, in particular, bonding interact with therapeutic interventions to promote insight or awareness into maladaptive patterns of thoughts/feelings/behaviors, assisting the client in improving self-image, and helping the client improving the image they have of others. Contrary to expectations, it was observed that high levels of agreement in the tasks can potentiate the symptomatology, when intervening for the emotional experience. The results of this study emphasize the importance of therapists promoting alliance before putting psychodynamic therapeutic interventions into practice.
The Therapy for Affect Phobias (TFA) is a model of Brief Psychodynamic Therapy (BPT), according to which the client's psychopathological symptoms are understood as a result of maladaptive defenses that individuals use to deal with feared emotions. That said, TFA aims to gradually expose the client to safe affective activation and the authentic experience of their emotions, to restructure affective phobias and improve the subject's symptomatology. For this to be possible, the therapeutic model attaches particular importance to the importance of the therapeutic alliance between the dyad, describing it as a “prerequisite” for the intervention applied by the therapist. However, the literature is relatively recent regarding the relevance of the therapeutic alliance for the effect of psychotherapeutic interventions, specifically in the AFT model. The present study aimed to analyze whether the results of psychodynamic therapeutic intervention, specific to the treatment of AFT, depend on the levels of therapeutic alliance. For the realization of the same, a sample was collected consisting of 31 clients monitored in a University Psychology Service and 3 therapists responsible for psychotherapeutic care. Clients answered the Working Alliance Inventory - Short Revised (WAI -SR) and the Outcome Questionnaire-10 (OQ-10), and the therapists answered the Achievement of Treatment Objectives Scales (ATOS) - Therapist Version. The collected data was organized using a hierarchical structure and analyzed using the method set by the Hierarchical Linear Modeling (HLM). The obtained results suggest that the client's symptomatic improvement occurs when high levels of therapeutic alliance and, in particular, bonding interact with therapeutic interventions to promote insight or awareness into maladaptive patterns of thoughts/feelings/behaviors, assisting the client in improving self-image, and helping the client improving the image they have of others. Contrary to expectations, it was observed that high levels of agreement in the tasks can potentiate the symptomatology, when intervening for the emotional experience. The results of this study emphasize the importance of therapists promoting alliance before putting psychodynamic therapeutic interventions into practice.
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Keywords
Terapia para as fobias de afetos Aliança terapêutica Intervenção do terapeuta Resultados terapêutico Sintomatologia do cliente