Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2017-0146
Trends in Psychiatry and Psychotherapy
Original Article

Interaction structures in the psychodynamic psychotherapy of a patient with chronic diseases and somatic symptoms

Estruturas de interação na psicoterapia psicodinâmica de uma paciente com doenças crônicas e sintomas somáticos

Pricilla Braga Laskoski; Simone Hauck; Stefania Pigatto Teche; Carolina Stopinski Padoan; Alcina Juliana Soares Barros; Fernanda Barcellos Serralta; Cláudio Laks Eizirik

http://dx.doi.org/10.1590/2237-6089-2017-0146 Trends Psychiatry Psychother, vol.41, n2, p.128-135, 2019
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Abstract

Abstract Objective This study aimed to identify and analyze the interaction structures (ISs) (patterns of reciprocal interaction between the patient-therapist dyad) that characterize the process of a successful long-term psychodynamic psychotherapy (28 months) of a patient with chronic diseases (lupus and fibromyalgia) and somatic symptoms. Methods The 113 sessions were videotaped and analyzed alternately (n = 60) by independent judges using the Psychotherapy Process Q-Set. Inter-rater reliability ranged from 0.60 to 0.90, with a mean of r = 0.71 (Pearson’s correlation). Through a principal component exploratory factor analysis, four ISs were identified. Result The patterns of interaction between patient and therapist showed clinical validity (i.e., they were easily interpretable in the context of the case under study). The ISs were non-linear and more or less prominent across different treatment sessions and stages. Some ISs were similar to those in other studies, and others were probably unique to the present process. In addition, some ISs were independent, whereas others were interrelated over time. Conclusion Process studies, such as the present one, seek to address questions about the characteristics of the interaction between patient and therapist as well as to identify particular patterns of interaction that are most prominent with a specific patient at a specific condition or time. Therefore, these studies can provide some support in establishing knowledge for clinical practice, assisting in the training of therapists, as well as in the elaboration of general guidelines for the technical management of patients with specific characteristics.

Keywords

Psychodynamic psychotherapy, process research, interaction structures, psychotherapeutic process

Resumo

Resumo Objetivo Este estudo objetivou identificar e analisar as estruturas de interação (interaction structures [ISs]) (padrões de interação recíproca entre a dupla paciente-terapeuta) que caracterizam o processo de uma psicoterapia psicodinâmica de longa duração (28 meses) de uma paciente com doenças crônicas (lúpus e fibromialgia) e sintomas somáticos. Métodos As 113 sessões foram filmadas e analisadas alternadamente (n = 60) por juízes independentes usando o Psychotherapy Process Q-Set. A confiabilidade entre avaliadores variou de 0.60 a 0.90, com média de r = 0.71 (correlação de Pearson). Por meio de uma análise fatorial exploratória do componente principal, foram identificadas quatro ISs. Resultados Os padrões de interação entre paciente e terapeuta mostraram validade clínica (ou seja, foram facilmente interpretáveis no contexto do caso em estudo). As ISs foram não lineares e mais ou menos proeminentes em diferentes sessões e etapas do tratamento. Algumas ISs foram semelhantes às de outros estudos, e outras provavelmente foram exclusivas do presente processo. Além disso, algumas ISs eram independentes, enquanto outras estavam inter-relacionadas ao longo do tempo. Conclusão Estudos de processo como o presente procuram abordar questões sobre as características da interação entre paciente e terapeuta, bem como identificar padrões particulares de interação que são mais proeminentes com um determinado paciente em condições ou momentos específicos. Portanto, esses estudos podem fornecer suporte ao estabelecimento de conhecimentos para a prática clínica, auxiliando na formação de terapeutas, bem como na elaboração de diretrizes gerais para o manejo técnico de pacientes com características específicas.

Palavras-chave

Psicoterapia psicodinâmica, pesquisa de processo, estruturas de interação, processo psicoterapêutico

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