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Questionar a intuição, sim e não! : um estudo experimental sobre tomada de decisão em psicoterapia
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Resumo(s)
Tendo por base teorias e modelos de conceptualização específicos, o uso de um raciocínio automático e intuitivo na tomada de decisão clínica, é essencial para que o terapeuta responda de forma rápida e frugal às necessidades do paciente ao longo do processo de mudança. Todavia, ao estar associado a enviesamentos cognitivos, este tipo de raciocínio pode resultar, por vezes, em decisões precipitadas e menos responsivas por parte do terapeuta que necessitam de ser alvo de reconsideração. Devido às características de uma sessão clínica, dúvidas surgem relativamente ao “como” e “quando” o envolvimento em tal processo mais deliberado pode ocorrer. Com base no paradigma de Implementação de Intenções de Gollwitzer e Brandstatter (1997), um teste de natureza experimental é decorrido com o objetivo de promover uma estratégia automática e auto-regulatória (plano Se_Então_), que ajude o terapeuta no contexto da sessão a considerar hipóteses alternativas à sua primeira intuição. Adicionalmente, procura-se perceber se marcadores específicos de capacidade de processamento do paciente, tal como conceptualizada pelo Metamodelo de Complementaridade Paradigmática (Vasco, 2001; 2006), influenciam o processo de tomada de decisão intuitiva e a consideração de hipóteses alternativas.
Uma estratégia de Implementação de Intenções, tal como formulada, não se mostrou eficaz na promoção do objetivo designado. Todavia, a responsividade face a marcadores de capacidade de processamento num primeiro julgamento, mostrou estar marginalmente associada à consideração de hipóteses clínicas alternativas: respostas menos responsivas aumentaram a probabilidade do terapeuta considerar outra hipótese. O facto de grande parte da amostra ter sido responsiva num primeiro julgamento, sugere que a investigação que se dedica à abstração e definição destes marcadores e respetivos emparelhamentos responsivos, tende a promover decisões responsivas no momento-a-momento da sessão. Em suma, conclui-se que não é ainda claro que terapeutas beneficiem do teste de decisões intuitivas neste contexto específico, nomeadamente quando são experientes e/ou peritos.
Based on theories and specific conceptualization models, the use of automatic and intuitive reasoning in clinical decision making is crucial for the therapist to respond quickly and frugally to patient's needs throughout the change process. Nevertheless, this type of reasoning is associated with cognitive biases which sometimes may lead to hasty and less responsive decisions that need to be reconsidered. Due to the characteristics of a clinical session, doubts arise about “how” and “when” the involvement in such deliberate process may occur. Based on Gollwitzer and Brandstatter (1997) Implementation Intentions paradigm, an experimental test is conducted to promote an automatic and self-regulatory strategy (If_Then_ plan) that helps the therapist throughout the clinical session to consider alternative hypotheses to his first intuition. In addition, this article wants to explore whether specific markers which demonstrate the patient’s processing capacity, as conceptualized by the Paradigmatic Complementarity Metamodel (Vasco, 2001; 2006), influence the intuitive decision-making process and the consideration of alternative hypotheses. As formulated in the present study, an Implementation Intentions strategy was not effective in promoting the established goal. However, the responsiveness to the processing capacity markers in a first clinical judgment, was marginally associated with the consideration of alternative clinical hypotheses: less responsive answers increased the probability of the therapist considering another answer. The fact that a large part of the sample has been responsive during the first judgment, suggests that models which are focused on the selection and definition of markers and their responsive pairings, tend to promote moment-by-moment responsive decisions. We conclude that it is not clear yet, that therapists benefit from testing their intuitive decisions in this specific context, especially when they are experienced and/or experts.
Based on theories and specific conceptualization models, the use of automatic and intuitive reasoning in clinical decision making is crucial for the therapist to respond quickly and frugally to patient's needs throughout the change process. Nevertheless, this type of reasoning is associated with cognitive biases which sometimes may lead to hasty and less responsive decisions that need to be reconsidered. Due to the characteristics of a clinical session, doubts arise about “how” and “when” the involvement in such deliberate process may occur. Based on Gollwitzer and Brandstatter (1997) Implementation Intentions paradigm, an experimental test is conducted to promote an automatic and self-regulatory strategy (If_Then_ plan) that helps the therapist throughout the clinical session to consider alternative hypotheses to his first intuition. In addition, this article wants to explore whether specific markers which demonstrate the patient’s processing capacity, as conceptualized by the Paradigmatic Complementarity Metamodel (Vasco, 2001; 2006), influence the intuitive decision-making process and the consideration of alternative hypotheses. As formulated in the present study, an Implementation Intentions strategy was not effective in promoting the established goal. However, the responsiveness to the processing capacity markers in a first clinical judgment, was marginally associated with the consideration of alternative clinical hypotheses: less responsive answers increased the probability of the therapist considering another answer. The fact that a large part of the sample has been responsive during the first judgment, suggests that models which are focused on the selection and definition of markers and their responsive pairings, tend to promote moment-by-moment responsive decisions. We conclude that it is not clear yet, that therapists benefit from testing their intuitive decisions in this specific context, especially when they are experienced and/or experts.
Descrição
Tese de mestrado, Psicologia (Secção de Psicologia Clínica e da Saúde, Núcleo de Psicoterapia Cognitiva-Comportamental e Integrativa), Universidade de Lisboa, Faculdade de Psicologia, 2018
Palavras-chave
Intuição Decisão clínica Teste de hipótese Teses de mestrado - 2018