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Resolução de rupturas na aliança terapêutica: Microanálise da interacção terapeuta-cliente em momentos de ruptura
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Enquadramento: Vários investigadores têm procurado desenvolver métodos que permitam captar o que acontece dentro das sessões de psicoterapia durante a interacção entre terapeuta e cliente, nomeadamente os processos específicos que se desenvolvem durante eventos de ruptura e resolução. Contudo, apesar da relevância destes métodos para a análise das flutuações na qualidade da aliança terapêutica a nível micro, até à data não foi realizada uma revisão dos estudos empíricos que utilizaram instrumentos de avaliação das rupturas e processos de resolução a partir da perspectiva de observadores externos. Objectivo: Realizar uma revisão sistemática dos estudos empíricos que avaliaram os processos de ruptura e resolução na aliança terapêutica em psicoterapia através da utilização de instrumentos baseados em cotações de avaliadores externos. Método: Foram realizadas pesquisas electrónicas nas bases de dados: PsycINFO, PsycARTICLES, PsycBOOKS, Psychology and Behavioral Sciences Collection, PEP Archive, Academic Search Complete, e E-Jounals, utilizando as palavras-chave: Alliance ruptures; e Therapy or Psychotherapy; e Instrument or measure or scale or tool or assessment; e Observer. Foram ainda realizadas pesquisas adicionais, a partir dos artigos seleccionados. Resultados: Foram incluídos 22 artigos empíricos que utilizaram os seguintes instrumentos de avaliação de rupturas e processos de resolução em psicoterapia, a partir da perspectiva de observadores externos: AROS, S-WAI-O, 3RS, CIS, e IVAT. Os estudos incluídos nesta revisão foram agrupados em 4 categorias: 1) Métodos de avaliação de rupturas e processos de resolução na aliança terapêutica; 2) Relação entre as rupturas na aliança terapêutica e o resultado da terapia; 3) Análise a nível micro dos processos de ruptura e resolução na aliança terapêutica; 4) Relação entre a aliança terapêutica, as rupturas na aliança e outras variáveis. Conclusões: A concordância entre métodos baseados em diferentes perspectivas para a avaliação das rupturas na aliança terapêutica é limitada. Foi encontrada uma relação entre os processos de ruptura-resolução e um melhor outcome da terapia, enquanto a existência de rupturas não reparadas ao longo do tratamento encontra-se associado a resultados terapêuticos negativos.
Background: Given the complex nature of alliance ruptures and resolution processes, researchers have sought to develop methods to capture what happens inside the psychotherapy sessions in the interaction between client and therapist, namely the specific therapeutic processes that take place during rupture and resolution events. Despite the significance of these methods for assessing fluctuations in the quality of the therapeutic alliance within-sessions, a systematic review of studies that used observer-based measures to detect alliance ruptures and resolution processes has not yet been performed. Objective: Conduct a systematic review of empirical studies that used observer-based measures for identifying alliance ruptures and resolution processes within psychotherapy sessions. Method: Electronic searches have performed using the search terms Alliance ruptures; and Therapy or Psychotherapy; and Instrument or measure or scale or tool or assessment; and Observer, in the electronic databases: PsycINFO, PsycARTICLES, PsycBOOKS, Psychology and Behavioral Sciences Collection, PEP Archive, Academic Search Complete, and E-Jounals. In addition a manual search was made based on the references of the selected articles. Results: We have identified 22 empirical studies that used the following observer-based coding systems to detect therapeutic alliance ruptures and resolution processes: AROS, S-WAI-O, 3RS, CIS, e IVAT. The studies included in the current review were divided into 4 categories: 1) Methods for assessing alliance ruptures and resolutions; 2) Relation between alliance ruptures and treatment outcome; 3) Micro level analysis of therapeutic alliance ruptures and resolution processes; 4) Relation between therapeutic alliance, alliance ruptures and other variables. Conclusions: Limited agreement has been found between different methods for the assessment of therapeutic alliance ruptures and resolutions. Findings suggest that rupture-resolution processes are related to better treatment outcomes, while unresolved ruptures are associated with poor therapeutic outcomes.
Background: Given the complex nature of alliance ruptures and resolution processes, researchers have sought to develop methods to capture what happens inside the psychotherapy sessions in the interaction between client and therapist, namely the specific therapeutic processes that take place during rupture and resolution events. Despite the significance of these methods for assessing fluctuations in the quality of the therapeutic alliance within-sessions, a systematic review of studies that used observer-based measures to detect alliance ruptures and resolution processes has not yet been performed. Objective: Conduct a systematic review of empirical studies that used observer-based measures for identifying alliance ruptures and resolution processes within psychotherapy sessions. Method: Electronic searches have performed using the search terms Alliance ruptures; and Therapy or Psychotherapy; and Instrument or measure or scale or tool or assessment; and Observer, in the electronic databases: PsycINFO, PsycARTICLES, PsycBOOKS, Psychology and Behavioral Sciences Collection, PEP Archive, Academic Search Complete, and E-Jounals. In addition a manual search was made based on the references of the selected articles. Results: We have identified 22 empirical studies that used the following observer-based coding systems to detect therapeutic alliance ruptures and resolution processes: AROS, S-WAI-O, 3RS, CIS, e IVAT. The studies included in the current review were divided into 4 categories: 1) Methods for assessing alliance ruptures and resolutions; 2) Relation between alliance ruptures and treatment outcome; 3) Micro level analysis of therapeutic alliance ruptures and resolution processes; 4) Relation between therapeutic alliance, alliance ruptures and other variables. Conclusions: Limited agreement has been found between different methods for the assessment of therapeutic alliance ruptures and resolutions. Findings suggest that rupture-resolution processes are related to better treatment outcomes, while unresolved ruptures are associated with poor therapeutic outcomes.
Descrição
Dissertação de Mestrado apresentada no ISPA – Instituto Universitário para obtenção de grau de Mestre na especialidade de Psicologia Clínica.
Palavras-chave
Rupturas na aliança Aliança terapêutica Medidas baseadas em observadores externos Psicoterapia. Alliance ruptures Therapeutic alliance Observer-based measures Psychotherapy