RESEARCH TOPICS

There are some research areas developed within the Psychotherapy and Change Research Program (you can find some publications on the respective page).

1.- Generic Change Indicators in Psychotherapy
2.- Change and stuck episodes
3.- The therapeutic Alliance in psychotherapy
4.- Communicative Actions during the Psychotherapeutic Conversation
5.- Emotion expression in the therapeutic process
6.- Focus in psychotherapy

1.- Generic Change Indicators in Psychotherapy | (top)

We have developed a hierarchy of 19 Generic Change Indicators (see the "products" section on this page), which allow research on therapeutic processes as well as the monitoring of these processes in order to provide feedback on therapeutic progress.

The Change Indicators have been applied to:

a) the study of different therapeutic schools and techniques, as they are clearly evident in different types of therapy;

b) the analysis of different stages of the therapeutic process, demonstrating their effectiveness in identifying phases in the evolution of change;

c) the examination of successful and unsuccessful therapies (as assessed by means of the OQ 42.5), proving useful in distinguishing one from another.

Currently, studies are underway to establish the relationship of the Change Indicators with verbal therapeutic activity, non-verbal communication, the expression of emotions and the therapeutic alliance.

This line of research is being developed by the following members of the Chilean Research Program on Psychotherapy and Change:

Mariane Krause (mkrause@uc.cl) J. Carola Perez & Karla Venegas



2.- Change and stuck episodes | (top)

Along the different research projects about psychotherapy change, attention was directed towards the in session moments in which change didn't happen, creating the concept of "Stuck Episode". The stuck episode is defined as the sustained reappearance of a pattern during a therapeutic session which is incompatible with change and is specifically related to the client's problem. This reappearance is characterized by the client's persistence in ways of understanding, behavior and emotions.

Substantive and methodological criteria were established to identify and delimit a stuck episode, as well as determining its possible topics, which were constructed as the opposite as already established change indicators (Krause et al, 2007).

These criteria were systematized in a proceedings manual, which allowed defining all the necessary steps to assure the desired reliability along observers (this manual will be uploaded in the "Products" section of the web page).

New members of the team went through a training process, reviewing and registering already identified change and stuck episodes, building a database for future access in the research project.

Initial analyses of a psychodynamic psychotherapy (Ramírez et al, 2009), comparing client's verbal activity in change and stuck episodes, show that the concept of "stuck episode" offers useful distinctions that enrich clinical work as well as psychotherapy process research. This pilot study will be replicated with 4 psychotherapies of different theoretical orientation, in order to evaluate is the specific results can be applied to new data.

This line of research is being developed by the following members of the Chilean Psychotherapy and Change Research Program:

Oriana Vilches Álvarez (anairova2@gmail.com), Pablo Herrera Salinas, Olga Fernández González, Andrea Noriega Bastidas, Ivonne Ramirez Claverié, Mariana Krebs & Marianne Daher.

3.- The therapeutic Alliance in psychotherapy | (top)

The Working Alliance Inventory (WAI) in its observational form developed by Tichenor (1989) has been adapted and translated to Spanish and has undergone a pilot application. The cultural adaptation was carried out following the procedures of translation and back-translation. A group of clinicians participated as expert judges in the assessment of content validity.

We are currently validating the WAI with a sample of 60 therapy sessions of different theoretical orientations and modalities. Concurrent validity will be analyzed using the self report forms of the same instrument that have been validated for the Chilean context by Santibánez (2003), based on the original forms developed by Horvath and Greenberg (1989). Divergent validity will be established using the Outcome Questionnaire (OQ-45.2) (Lambert, 1996). Inter-rater reliability will be estimated through inter-class correlations (ICC).

The validation of this instrument will allow the assessment of the quality of the therapeutic alliance in its dimensions of bond, tasks and goals based on the observation of therapeutic processes, and its comparison with patients' and therapists' self-reports, as well as its evolution along the process of therapy.

Subsequently, this line of research intends to develop an instrument for the assessment of the quality of the therapeutic alliance within significant in-session episodes of the therapeutic process, such as change and stuck episodes. The aim is to establish relationships between the therapeutic alliance and the verbal and non verbal activity of patients and therapists.

This line of research is developed by the following members of the Psychotherapy and Change Chilean Research Program:

Carolina Altimir (caltimir@uc.cl), Carlos Vöhringer, J. Carola Pérez, Claudio Martínez Guzmán and Paula Dagnino.

4.- Analysis of Communicative Actions during the Psychotherapeutic Conversation | (top)

1. The research team has developed a Therapeutic Activity Coding System (SCAT-1.0), applicable to the Communicative Actions of both, therapist and the patient, during the psychotherapeutic conversation.

2. This classification system includes four levels of analysis: Basic Forms, Communicative Intentions, Techniques and Content.

3. The reliability of the System has been demonstrated for the four levels of analysis.

4. It has also developed a Manual of Procedures, which includes the steps to consider at the moment of coding relevant episodes of the therapeutic process.

5. There are analysis for describing and comparing the Communicative Actions of both, therapist and patient, in different modalities and therapeutic approaches.

6. We are coding different types of episodes during the psychotherapeutic process (Change Episodes and Stagnation Episodes).

Nelson Valdés (In charge, nlvaldes@uc.cl) Mariane Krause Alemka Tomicic

5.- Emotion expression in the therapeutic process | (top)

This line of research is interested in studying the affective processes and emotional manifestations during patient-therapist exchange in relevant episodes of the therapeutic process. It is of particular interest to examine the emotion expression both in its verbal and non verbal dimensions. For these purposes, members of the research group are coding patient and therapist verbal behavior, specifically their communicative actions, in change and stuck episodes, using the Therapeutic Action Coding System. During this process, they are identifying communicative actions that have an emotional quality.

At the same time, patients' and therapists' facial affective non verbal behavior will be examined using the Facial Action Coding System (FACS). Facial behavior will be analyzes during change and stuck episodes, as well as in episodes of rupture and resolution of the alliance. Relationships will be established between the emotional verbal and non verbal behavior of therapy participants, and patterns of patient-therapist affective regulation will be identified. Likewise, relationships between these behaviors and the quality of the therapeutic Alliance, the Generic Change Indicators and therapeutic outcome will be established.

This line of research is in charge of the following members of the research group:

Carolina Altimir (caltimir@uc.cl) Nelson Valdés (nvaldes.sanchez@gmail.com), Alemka Tomicic, Claudio Martínez Guzmán & Paula Dagnino.

6.- Focus in psychotherapy | (top)

Contemporary therapists have been called to deliver treatments with higher levels of effectiveness andbriefness. To fullfill this demand, brief psychodynamic psychotherapy practice has emphasize theimportance of establishing a psychodynamic specific focus for the treatment, versus more comprehensive objectives framed for long treatments (Scaturo, 2002). Focalization is considered as an operation that involves reducing, theoretically and technically, problems raised by the patient to make them accessible to treatment. This will allow shortening treatment, since it provides to therapist a guide for their interventions, allowing him and patient, to link experiences that apparently were not related. This way patient accomplishes more insight and mastery on a central topic in a brief time period (Jiménez, 2005)

Although the focus usefulness is widely accepted, conceptualizations or approximations to their definition are diverse (Fiorini, 2000) all of them agree on the importance of working on it during therapeutic process, as an important element for the patient change.

Although there are many atemps to operationalize focus, (CCRT "Core Conflictual Relationship Theme", Luborsky & Crits-Christoph, 1990; Maladaptative Cyclic Model, Schatch, Binder & Strupp, 1984) the present project ascribe to the Operationalyzed Psychodynamic Diagnosis (OPD, OPD Task-Force, 2001), that allows an initial dynamic formulation and make easier focalization, focusing on different aspects of personality, resulting in an inclusive way to operationalize.

From empirical studies, and as a result of studies that didn't have this dilemma, psychotherapeutic processes seems to have an irregular trajectory, with advances and backward movements. This has been demonstrated especially in studies that use the assimilation model of Stiles (Stiles, et al, 1990), such as the Gabalda's studies (2006a, 2006b). This studies support the clinical experience, where is hard to think that there is only one focus for all the treatment and that the way patient deals or assimilates it, is not in a lineal way, but also irregular.

Due the importance of the focus in the therapeutic process for the patient changes, it's interesting what, how and when the focus is changing. Therefore, the investigation objective is to study therapeutic focus in brief psychodynamic processes, with the purposes of determining it's characteristics (the different foci), it's trajectories through the process and the evolution of the way the patient assimilates this problematic areas, establishing the relation of this with change indicators and therapeutic outcome.

Paula Dagnino R.