Desenvolvimento de protótipos brasileiros de psicoterapia psicodinâmica e terapia cognitivo-comportamental de crianças

Fiorini, Guilherme Pacheco; Ramires, Vera Regina Röhnelt

doi:10.1590/2237-6089-2018-0053

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Sumário

Original Articles • Trends Psychiatry Psychother. 41 (2) • Apr-Jun 2019 • https://doi.org/10.1590/2237-6089-2018-0053 copiar

Desenvolvimento de protótipos brasileiros de psicoterapia psicodinâmica e terapia cognitivo-comportamental de crianças

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Introdução

Este estudo desenvolveu protótipos brasileiros de psicoterapia psicodinâmica (PP) e terapia cognitivo-comportamental (TCC) para crianças com transtornos internalizantes (TI) e externalizantes (TE).

Método

Dezoito experts brasileiros em PP (n = 9) e TCC (n = 9) classificaram os 100 itens do Child Psychotherapy Q-Set (CPQ) descrevendo uma sessão hipotética típica de acordo com suas respectivas abordagens teóricas para crianças com TI. Depois, eles classificaram os mesmos itens descrevendo uma sessão hipotética típica para crianças com TE. Foi realizada uma análise fatorial do tipo Q com rotação varimax.

Resultados

As correlações dos experts foram altas, considerando ambas as abordagens teóricas e as duas categorias diagnósticas. A análise fatorial gerou três fatores independentes. As avaliações da TCC concentraram-se em um fator, enquanto as avaliações da PP geraram um fator que descreveu o tratamento de crianças com TI e um outro fator que descreveu o tratamento de crianças com TE.

Conclusão

O protótipo único da TCC refletiu uma conceptualização geral dessa abordagem, indiscriminada em relação aos sintomas da criança. O protótipo da PP para crianças com TI evidenciou um processo focado na interpretação, enquanto o protótipo da PP para crianças com TE caracterizou um processo suportivo com atenção à relação terapêutica. Infere-se uma maior variação no processo em PP para crianças com diferentes sintomatologias.

Descritores
Processos psicoterapêuticos; psicologia da criança; psicoterapia psicodinâmica; terapia cognitiva

	CBT	PDT-INT	PDT-EXT	CBT-2016	PDT-2016
CBT	-
PDT-INT	0.10	-
PDT-EXT	0.01	0.01	-
CBT-2016	0.86*	0.17	0.11	-
PDT-2016	0.22^†	0.71*	0.52*	0.36*	-

Item	Item description	z-score
15 most characteristic items
Item 55	T directly rewards desirable behaviors.	1.75154
Item 27	There is a focus on helping C plan behavior outside the session.	1.70854
Item 57	T attempts to modify distortions in C’s beliefs.	1.63523
Item 17	T actively exerts control over the interaction.	1.62019
Item 37	T behaves in a didactic manner.	1.59235
Item 68	Real rather than fantasized meanings of experience are actively differentiated.	1.18621
Item 87	T informs C of the potential impact of his or her behavior on others.	1.1524
Item 77	T’s interaction with C is sensitive to the C’s level of development.	1.05425
Item 3	T’s remarks are aimed at encouraging C’s speech.	1.01292
Item 82	T helps C manage feelings.	0.98647
Item 64	C draws T into play.	0.98073
Item 74	Humor is used.	0.96376
Item 4	There is discussion of why C is in therapy.	0.95799
Item 48	T sets limits.	0.89379
Item 99	T offers help or guidance.	0.88613
15 least characteristic items
Item 9	T is nonresponsive [vs. affectively engaged].	-2.38352
Item 24	T’s emotional conflicts intrude into the relationship.	-2.13738
Item 41	C does not feel understood by the therapist.	-2.1017
Item 42	C ignores or rejects T’s comments and observations.	-1.87968
Item 18	T is judgmental and conveys lack of acceptance.	-1.77472
Item 44	C feels wary or suspicious [vs. trusting and secure].	-1.69582
Item 56	C is distant from his or her feelings.	-1.67876
Item 40	C communicates without affect	-1.65156
Item 46	T interprets the meaning of C’s play.	-1.63852
Item 93	T is neutral.	-1.59413
Item 49	C conveys or expresses mixed or conflicted feelings about the T.	-1.45069
Item 95	C’s play lacks spontaneity.	-1.41247
Item 1	C expresses negative feelings toward T [vs. expresses approval or admiration].	-1.30022
Item 11	Sexual feelings or thoughts emerge.	-1.28182
Item 26	C is socially misattuned or inappropriate.	-1.27813

Item	Item description	z-score
15 most characteristic items
Item 93	T is neutral.	1.68598
Item 67	T interprets warded-off or unconscious wishes, feelings, or ideas.	1.59958
Item 46	T interprets the meaning of C’s play.	1.59498
Item 36	T points out C’s use of defenses	1.27224
Item 90	C’s dreams or fantasies are discussed.	1.26531
Item 71	C engages in make-believe play.	1.24598
Item 92	C’s feelings or perceptions are linked to situations or behavior in the past.	1.16181
Item 76	T makes links between C’s feelings and experience.	1.1147
Item 28	T accurately perceives the therapeutic process.	1.08684
Item 29	The quality of C’s play is fluid, absorbed [vs. fragmented, sporadic].	1.07079
Item 94	C feels sad or depressed [vs. cheerful and joyous].	1.06808
Item 97	T emphasizes verbalization of internal states and affects.	1.03954
Item 35	C’s self-image is a theme	1.0348
Item 98	The therapy relationship is discussed.	1.03219
Item 62	T points out a recurrent theme in the C’s experience or conduct.	1.02552
15 least characteristic items
Item 37	T behaves in a didactic manner.	-2.22772
Item 55	T directly rewards desirable behaviors.	-2.12517
Item 17	T actively exerts control over the interaction.	-2.11295
Item 89	T acts to strengthen existing defenses.	-1.90235
Item 27	There is a focus on helping the C plan behavior outside the session.	-1.67804
Item 20	C is provocative; challenges the T or rules and boundaries of the therapy hour	-1.65222
Item 9	T is nonresponsive [vs. affectively engaged].	-1.61633
Item 21	T self-discloses.	-1.60836
Item 18	T is judgmental and conveys lack of acceptance.	-1.54588
Item 12	T models unspoken or unelaborated emotions.	-1.52111
Item 87	T informs C of the potential impact of his or her behavior on others.	-1.3667
Item 39	C is competitive, rivalrous with the T.	-1.33474
Item 42	C ignores or rejects T’s comments and observations.	-1.31019
Item 83	C is demanding.	-1.30329
Item 66	T is directly reassuring.	-1.30164

Item	Item description	z-score
15 most characteristic items
Item 20	C is provocative; challenges the T or rules and boundaries of the therapy hour.	1.93796
Item 39	C is competitive, rivalrous with the T.	1.85937
Item 25	C has difficulty leaving the session.	1.58184
Item 83	C is demanding.	1.51339
Item 72	C is active.	1.42051
Item 84	C expresses anger or aggressive feelings.	1.40056
Item 58	C appears unwilling to examine thoughts, reactions, or motivations related to problems.	1.29129
Item 1	C expresses negative feelings toward T [vs. expresses approval or admiration].	1.26032
Item 34	C blames others, or external forces, for difficulties.	1.24306
Item 42	C ignores or rejects therapist’s comments and observations.	1.17397
Item 48	T sets limits.	1.07023
Item 98	The therapy relationship is discussed.	1.00936
Item 49	C conveys or expresses mixed or conflicted feelings about the T.	0.97405
Item 100	T draws connections between the therapeutic relationship and other relationships.	0.92728
Item 45	T tolerates C’s strong affect or impulses.	0.9164
15 least characteristic items
Item 078	C is compliant.	-2.19431
Item 053	C conveys awareness of own internal difficulties.	-2.12946
Item 061	C feels shy and embarrassed [vs. un-self-conscious and assured].	-2.05707
Item 024	T’s emotional conflicts intrude into the relationship.	-1.88034
Item 080	C behaves in a dependent fashion [vs. insists on independence].	-1.66623
Item 029	The quality of C’s play is fluid, absorbed [vs. fragmented, sporadic].	-1.65251
Item 070	C struggles to control feelings or impulses.	-1.64499
Item 018	T is judgmental and conveys lack of acceptance.	-1.54903
Item 095	C’s play lacks spontaneity.	-1.54041
Item 055	T directly rewards desirable behaviors.	-1.43581
Item 085	C’s aggression is directed toward self.	-1.3889
Item 040	C communicates without affect	-1.38718
Item 073	C expresses fears or displays phobic behavior.	-1.38657
Item 054	C is clear and organized in verbal expression.	-1.24431
Item 056	C is distant from his or her feelings.	-1.15499

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[1] Correspondence: Guilherme Fiorini. Department of Clinical, Educational and Health Psychology - University College London 1-19 Torrington Place WC1E 7HB - London, UK E-mail: guilherme.fiorini@outlook.com