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Doctoral Thesis
DOI
10.11606/T.47.2011.tde-04112011-113836
Document
Author
Full name
Claudia Kami Bastos Oshiro Clemente
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2011
Supervisor
Committee
Meyer, Sonia Beatriz (President)
Hübner, Maria Martha Costa
Kanter, Jonathan William
Reis, Maria de Jesus Dutra dos
Silveira, Jocelaine Martins da
Title in Portuguese
Delineamento experimental de caso único: a psicoterapia analítica funcional com dois clientes difíceis
Keywords in Portuguese
Análise do comportamento
Delineamento experimental
Processos psicoterapêuticos
Psicoterapia analítica
Abstract in Portuguese
A psicoterapia analítica funcional (FAP) foi criada no final da década de oitenta por Kohlenberg e Tsai como uma tentativa de explicar em termos analítico-comportamentais a interação terapêutica como instrumento capaz de promover mudanças comportamentais. Atualmente, este tipo de psicoterapia vem obtendo validação empírica e está se consolidando com uma psicoterapia eficaz para os casos clínicos considerados difíceis, que geralmente são aqueles que apresentam algum tipo de dificuldade nos relacionamentos interpessoais. Entretanto, há escassez de trabalhos que mostram as variáveis do processo terapêutico, ou seja, variáveis do terapeuta e do cliente que favorecem e/ou dificultam o andamento da terapia e os processos e procedimentos responsáveis pela mudança comportamental do cliente. Diante deste cenário, o presente trabalho teve como objetivo avaliar os efeitos de introdução e retirada das intervenções FAP sobre as seguintes categorias criadas a partir de observações clínicas da pesquisadora de alguns comportamentos em sessão (comportamentos clinicamente relevantes, CCRs) que estariam dificultando o andamento da psicoterapia com clientes difíceis: 1) verborragia, 2) falta de correspondência com a fala do terapeuta, 3) fala superficial e, 4) agressões verbais. Foram selecionados dois participantes com problemas de relacionamento interpessoal que já faziam terapia com a pesquisadora, tendo como linha de base um processo psicoterápico bem consolidado, o que possibilitou o controle de algumas variáveis intervenientes (relação terapêutica estabelecida e baixa probabilidade de desistência). As sessões foram filmadas e os instrumentos de medida utilizados foram: a) Sistema multidimensional de categorização da interação terapêutica e, b) Escala de classificação da Psicoterapia Analítica Funcional FAPRS. O delineamento experimental de caso único apresentou o arranjo A-B1-C1-B2-C2, sendo: A- terapia sem intervenções programadas; B1 e B2- introdução da FAP e, C1 e C2- retirada da FAP. As 40 sessões de terapia, 20 para cada cliente, foram transcritas e categorizadas. Os resultados indicaram que as categorias dos clientes com maior porcentagem de ocorrência foram as de Relato, Estabelecimento de relação entre eventos e Oposição. Já as da terapeuta foram as de Facilitação, Empatia e Solicitação de relato. Com a manipulação da variável independente (FAP), o delineamento experimental permitiu mostrar que a porcentagem de ocorrência dos comportamentos que dificultam o andamento da terapia (CCRs1) diminuiu nas fases de introdução da FAP e, o inverso ocorreu quando a FAP foi retirada. Os comportamentos que favoreciam o andamento da terapia (CCRs2) e análises feitas pelos clientes (CCRs3) apresentaram a tendência oposta, ou seja, aumentaram a porcentagem de ocorrência nas fases de introdução da FAP e diminuíram nas fases de retirada da FAP. Este delineamento se mostrou útil para a pesquisa em psicoterapia e os resultados corroboraram que o principal mecanismo de mudança envolvido na FAP é a modelagem direta dos CCRs ocorrendo em sessão, no contexto da relação terapêutica
Title in English
Single-case experimental design: Functional Analytic Psychotherapy with two difficult clients
Keywords in English
Analytical psychotherapy
Behavioral assessment
Experimental design
Psychotherapeutic process
Abstract in English
Functional Analytic Psychotherapy (FAP) was created in the late eighties by Kohlenberg and Tsai as an attempt to explain, in behavioral-analytic terms, the therapeutic interaction as an instrument to promote behavioral changes. Currently, this kind of psychotherapy is obtaining empirical validation and is emerging as an effective psychotherapy for difficult clinical cases, which are usually those with some kind of difficulty in interpersonal relationships. However, there are just a few researches that show the variables of the therapeutic process, that is, variables of the client and therapist who favor and/or hinder the progress of therapy and the processes and procedures responsible for behavioral change. The present study aimed to evaluate the effects of the introduction and withdrawal of FAP interventions on the following categories created from the researchers clinical observations of some behaviors in session (clinically relevant behaviors, CRBs) that were affecting the progress of psychotherapy with difficult clients: 1) verbose talking, 2) talking with no correspondence with the therapist speech, 3) superficial speech and 4) aggressive verbal responses. Two participants with interpersonal relationship problems were selected and were in therapy with the researcher so the baseline was a well consolidated psychotherapy process, which allowed the control of some variables (therapeutic relationship established and low probability of discontinuing therapy). The sessions were video recorded and the measuring instruments were: a) multidimensional system for coding behaviors in therapist-client interaction, b) Functional Analytic Psychotherapy rating scale FAPRS. The single-case experimental design was the following: A-B1-B2-C1-C2 (A= the therapy without planned interventions; B1 and B2-introduction of FAP and, C1 and C2- FAP withdrawal). The 40 therapy sessions, 20 for each client, were transcribed and coded. The results indicated that the clients' categories with higher percentage of occurrence were Reports, Establishment of relation between events, and Opposition. The therapist's were Empathy, Facilitation and Request report. With the manipulation of the independent variable (FAP), the experimental design showed that the percentage of occurrence of behaviors that affect the progress of therapy (CRBs1) decreased in the phases of FAP and the inverse occurred when FAP was withdrawn. The behaviors that helped the progress of therapy (CRBs2) and clients analyses (CRBs3) showed the opposite trend, i.e. increased the percentage of occurrence in the phases of FAP and decreased in phases of FAP withdrawal. This experimental design proved to be useful for the research in psychotherapy and the results confirm that the main mechanism of change involved in FAP is the direct shaping of CRBs occurring in session, within the context of the therapeutic relationship
 
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Publishing Date
2011-11-07
 
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