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A perspectiva do paciente sobre processos e mecanismos de mudança em psicoterapia, em contexto naturalístico
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Resumo(s)
Nos últimos anos, tem havido um reconhecimento do papel do paciente enquanto participante
activo na Psicoterapia, pelo que existe substancial evidência de que as suas percepções,
expectativas e preferências relacionam-se com os resultados finais.
A partir da perspectiva do paciente, actualmente em terapia, em contexto naturalístico, o
objectivo da presente dissertação é explorar, diferenciar e compreender os processos que
ocorrem dentro de sessão relacionados com micro-mudanças (processos de mudança), bem
como, as capacidades e competências resultantes, que são demonstradas e generalizadas no
quotidiano (mecanismos de mudança).
Para tal, foi utilizada uma metodologia qualitativa, de carácter exploratório, com uma amostra
de 15 participantes. Através do método de Análise Temática foram encontradas três categorias
gerais: Processos de Mudança do Paciente, Processos de Mudança da Terapia e Mecanismos
de Mudança.
Entre várias categorias, aumento da consciência da experiência e do Self e construção de
novos significados relativos à experiência e ao Self como processos de mudança facilitadores,
que ocorrem dentro de sessão. A comunicação terapêutica e a promoção de novos
significados são os processos de mudança da terapia mais reportados. Por fim, a
implementação de acções reparadoras e compromisso com o trabalho terapêutico e
crescimento psicológico traduzem os mecanismos de mudança, manifestadas fora de sessão.
Conclui-se que os participantes foram capazes de verbalizar as suas percepções e as suas
opiniões acerca das suas mudanças, do trabalho realizado em sessão e do impacto do mesmo
no quotidiano, como mudanças intermédias no seu processo terapêutico.
São consideradas limitações e implicações para a investigação futura e prática clínica.
In recent years, there has been a shift towards the recognition of the patient’s role as an active participant in Psychotherapy. There is also a substantial amount of evidence that many patient’s perceptions, expectations and preferences do relate to outcome. Learning from patient’s perspective, currently in naturalistic settings, the general goal of this thesis is to explore, differentiate and understand the in-session processes related to change at the session level (change processes), as well as the resulting capacities or skillful means, as manifested and generalized in daily life (change mechanisms). A qualitative methodology and exploratory was used to collect data from 15 participants. Using a Thematic Analysis, three main categories were filled: Client Change Processes, Therapy Change Processes and Change Mechanisms. Among several categories, the results highlight increased awareness of Self and experience, as well new meaning making regarding Self and experience as helpful change processes that occur in-session. Therapeutic communication and promotion of new meaning making are the most reported therapy change processes. Implementation of repairing actions and commitment to the therapeutic work and psychological growth reflect the top change mechanisms expressed out-session. In conclusion, it was clear that patients were able to express their own perceptions and opinions about their changes, their work in sessions and the impact in daily life, as intermediate results of their therapy processes. Limitations of this study are presented and clinical, theoretical and future research implications are discussed.
In recent years, there has been a shift towards the recognition of the patient’s role as an active participant in Psychotherapy. There is also a substantial amount of evidence that many patient’s perceptions, expectations and preferences do relate to outcome. Learning from patient’s perspective, currently in naturalistic settings, the general goal of this thesis is to explore, differentiate and understand the in-session processes related to change at the session level (change processes), as well as the resulting capacities or skillful means, as manifested and generalized in daily life (change mechanisms). A qualitative methodology and exploratory was used to collect data from 15 participants. Using a Thematic Analysis, three main categories were filled: Client Change Processes, Therapy Change Processes and Change Mechanisms. Among several categories, the results highlight increased awareness of Self and experience, as well new meaning making regarding Self and experience as helpful change processes that occur in-session. Therapeutic communication and promotion of new meaning making are the most reported therapy change processes. Implementation of repairing actions and commitment to the therapeutic work and psychological growth reflect the top change mechanisms expressed out-session. In conclusion, it was clear that patients were able to express their own perceptions and opinions about their changes, their work in sessions and the impact in daily life, as intermediate results of their therapy processes. Limitations of this study are presented and clinical, theoretical and future research implications are discussed.
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, 2014
Palavras-chave
Processos de mudança Processo terapêutico Psicoterapia Teses de mestrado - 2014