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Responsividade do terapeuta e mudança de padrões interpessoais disfuncionais do paciente ao longo do processo psicoterapéutico
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Orientador(es)
Resumo(s)
Considerando o potencial integrativo do conceito de responsividade e sua utilidade
para a compreensão da relação entre factores comuns e ganhos terapêuticos, foi proposta a
definição de uma instância do conceito de responsividade, baseada no meta-modelo de
Complementaridade Paradigmática (Vasco, 2001). Foi proposta uma medida quantitativa
dessa instância definida- índice de Responsividade (IR). Hipotetizou-se que uma relação
responsiva promovesse mudanças no funcionamento interpessoal dos pacientes, no sentido
de diminuição da disfuncionalidade. O funcionamento interpessoal do paciente foi
estudado recorrendo à medida Person's Relating to Others Questionnaire (PROQ3, Birtchnell, n.
public.) que foi adaptada para o contexto clínico português. Colocou-se a hipótese da
responsividade contribuir para o desenvolvimento de boas alianças e melhores ganhos
terapêuticos. Realizaram-se dois estudos transversais, com amostras de terapeutas e
pacientes de psicoterapia de diferentes orientações teóricas. No Estudo 1, analisaram-se as
qualidades psicométricas das medidas INTT- Inventário de Necessidades de Trabalho Terapêutico
e PROQ3, encontrando bons resultados de consistência interna e validade. No Estudo 2,
verificou-se que o IR explicava alguma variância da estimativa que o paciente faz das suas
melhorias e da sua percepção da qualidade da aliança terapêutica. Quanto mais responsiva a
actuação do terapeuta, mais os pacientes estimavam positivamente as suas melhorias e a
qualidade da aliança. Não foi encontrado suporte empírico para a hipótese da
responsividade contribuir para a diminuição de disfuncionalidade interpessoal do paciente,
nem para explicar os ganhos terapêuticos globais. A percepção do terapeuta acerca da
qualidade da aliança explicava variância de disfuncionalidade interpessoal do paciente, no
sentido de a melhor qualidade da aliança se associarem menores níveis de
disfuncionalidade. Os pacientes estimaram melhorias em terapia de forma tanto mais
positiva, quando melhor a sua percepção da aliança terapêutica. Esta investigação
apresentou dados empíricos de relação entre responsividade e apreciação da qualidade da
aliança na perspectiva do paciente, bem como da percepção que este tinha acerca das suas
melhorias em terapia, que reforçaram a ideia de importância teórica e clínica do conceito de
responsividade. Apontaram-se limitações e alternativas metodológicas para estudar o
contributo da responsividade do terapeuta na redução de disfuncionalidade interpessoal do
paciente.
This study tries to contribute to the definition of an instance of responsivity in psychotherapy based on the meta-model Paradigmatic Complementarity (Vasco, 2001). The potencial of the concept of responsivity to psychotherapy integration and it’s relevance in understanding of the relationship between common factors and outcome are acknowledged. A quantitative measure of that instance of responsivity - Responsivity Index (IR) was proposed. It was hypothesized that a responsive relationship in therapy would promote a decrease on patient’s disfunctionality in interpersonal relating. Patient’s interpersonal functioning was measured with Person's Relating to Others Questionnaire (PROQ3, Birtchnell, n. publ.). The PROQ3 measure was adapted to Portuguese clinical context. It was studied if responsivity contributed to the development of good therapeutic alliances and better outcomes. Two transversal research designs were conducted, with samples of therapists and patients in psychotherapy of different theoretical orientations. Study 1 analysed the psychometric proprieties of the instruments: INTT- Inventoiy of Needs of Therapeutic Work and PROQ3. Good reliability and support for validity were found for the INTT and PROQ3. In Study 2, results showed that the IR explained some of the variance of estimated improvement in patient’s perspective and patient’s evaluation of the quality of the therapeutic alliance. The more responsive the therapist’s strategic intervention was, the better was the patient’s perception of his(her) improvement in therapy as well as his(her) perception of the quality of the alliance. It was not found empirical support neither for the hypothesis of responsivity promoting interpersonal difunctionality reduction, nor for the hypothesis of IR explaining general outcome. However, therapist’s perspective on the quality of alliance explained some of the variance of patient’s interpersonal difunctionality. Better alliances were related with lower results in patient’s difunctionality. Patient’s estimation of improvement was higher when the quality of alliance in his(her) perspective was good. Empirical data is presented supporting the relation between responsivity, as conceptualized, and the quality of therapeutic alliance and estimation of improvement, both in patient’s perspective. This findings stress the theoretical and clinical importance of the concept of responsivity in psychotherapy. Some limitations and methodological alternatives are advanced, considering future research regarding the explaining potential of the concept of responsivity and the understanding of changes in patient’s interpersonal relating.
This study tries to contribute to the definition of an instance of responsivity in psychotherapy based on the meta-model Paradigmatic Complementarity (Vasco, 2001). The potencial of the concept of responsivity to psychotherapy integration and it’s relevance in understanding of the relationship between common factors and outcome are acknowledged. A quantitative measure of that instance of responsivity - Responsivity Index (IR) was proposed. It was hypothesized that a responsive relationship in therapy would promote a decrease on patient’s disfunctionality in interpersonal relating. Patient’s interpersonal functioning was measured with Person's Relating to Others Questionnaire (PROQ3, Birtchnell, n. publ.). The PROQ3 measure was adapted to Portuguese clinical context. It was studied if responsivity contributed to the development of good therapeutic alliances and better outcomes. Two transversal research designs were conducted, with samples of therapists and patients in psychotherapy of different theoretical orientations. Study 1 analysed the psychometric proprieties of the instruments: INTT- Inventoiy of Needs of Therapeutic Work and PROQ3. Good reliability and support for validity were found for the INTT and PROQ3. In Study 2, results showed that the IR explained some of the variance of estimated improvement in patient’s perspective and patient’s evaluation of the quality of the therapeutic alliance. The more responsive the therapist’s strategic intervention was, the better was the patient’s perception of his(her) improvement in therapy as well as his(her) perception of the quality of the alliance. It was not found empirical support neither for the hypothesis of responsivity promoting interpersonal difunctionality reduction, nor for the hypothesis of IR explaining general outcome. However, therapist’s perspective on the quality of alliance explained some of the variance of patient’s interpersonal difunctionality. Better alliances were related with lower results in patient’s difunctionality. Patient’s estimation of improvement was higher when the quality of alliance in his(her) perspective was good. Empirical data is presented supporting the relation between responsivity, as conceptualized, and the quality of therapeutic alliance and estimation of improvement, both in patient’s perspective. This findings stress the theoretical and clinical importance of the concept of responsivity in psychotherapy. Some limitations and methodological alternatives are advanced, considering future research regarding the explaining potential of the concept of responsivity and the understanding of changes in patient’s interpersonal relating.
Descrição
Tese de Mestrado em Psicologia (Área de Especialização em Mudança e Desenvolvimento em Psicoterapia) apresentada à Universidade de Lisboa através da Faculdade de Psicologia e de Ciências da Educação, 2005
Palavras-chave
Teses de mestrado - 2005 Psicoterapia Relações humanas Complementaridade paradigmática