Development of a Brazilian Portuguese version of the questionnaire on relationships pattern Beziehungs-Muster Fragebogen

Abstracts

INTRODUÇÃO: O desenvolvimento da versão em português do Brasil do Beziehungs-Muster Fragebogen, conhecido na literatura internacional como Relationship Patterns Questionnaire, questionário que avalia o padrão central de relação, visa à introdução, em nosso meio, de uma medida auto-aplicável para implementação de projetos de pesquisa cuja questão envolva o construto transferência. METODOLOGIA: As etapas para o desenvolvimento da versão foram: obtenção da licença dos autores; tradução do instrumento original para o português do Brasil; julgamento e ajuste do material traduzido por profissionais da área da psiquiatria e psicologia; retrotradução; julgamento da equivalência semântica; consenso de profissionais da área da psiquiatria e psicologia sobre a adequação do instrumento à nossa cultura; interlocução com a população-alvo. CONCLUSÃO: O Beziehungs-Muster Fragebogen é uma medida auto-aplicável, para avaliação da transferência ou padrão central da relação, que poderá facilitar a implementação de projetos para investigar os aspectos da relação terapêutica adjuntos à transferência. É um método de fácil aplicação e análise, baixo custo e que dispensa o uso de vídeos ou gravadores na sessão. Estudos investigatórios acerca do padrão de relação poderão fornecer mais resultados sobre a adaptabilidade desse instrumento à nossa cultura.

Beziehungs-Muster Fragebogen; Relationship Patterns Questionnaire; transferência

ORIGINAL ARTICLE

Development of a Brazilian Portuguese version of the questionnaire on relationships pattern Beziehungs-Muster Fragebogen

Eliane Bernadete Ferreira^I; Maria Lúcia Tiellet Nunes^II; Regina A. Kurth^III; Dan Pokorny^IV; Luciana Terra^V; Simone Hauck^VI; Lúcia Helena Freitas Ceitlin^VII

^IPsychiatrist. MSc. student, Graduate Program in Medical Sciences: Psychiatrist, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil

^IIPsychologist. PhD. Professor, Psychology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil. Coordinator, Graduation Program in Psychology, PUCRS, Porto Alegre, RS, Brazil

^IIIUniversity of Giessen, Germany

^IVUniversity of Ulm, Germany

^VPsychologist. MSc. student, Graduate Program in Medical Sciences: Psychiatry, UFRGS, Porto Alegre, RS, Brazil

^VIPsychiatrist. PhD student, Graduate Program in Medical Sciences: Psychiatry, UFRGS, Porto Alegre, RS, Brazil

^VIIPsychiatrist. MpH, PhD. Associate professor, Department of Psychiatry and Forensic Medicine, Faculdade de Medicina, UFRGS, Porto Alegre, RS, Brazil

^{Correspondence}

ABSTRACT

INTRODUCTION: The Beziehungs-Muster Fragebogen (BeMus-3), known in the international literature as the Relationship Patterns Questionnaire (RPQ), is a questionnaire that evaluates the central pattern of relationship. The development of its Brazilian Portuguese version aims at introducing, in our country, a self-report measurement to implement research projects involving the construct of transference.

METHODOLOGY: The development stages of this version were: obtaining permission from the authors; translation of the original instrument into Brazilian Portuguese; evaluation and adjustment of the translated material by psychiatry and psychology professionals; back-translation; evaluation of semantic equivalence; consensus of psychiatry and psychology professionals on the adequacy of the instrument to our culture; interchange with the target population.

CONCLUSION: BeMus-3 is a self-report measurement to assess the transference or central pattern of relationship that can facilitate the implementation of projects to investigate the transference-related aspects of therapeutic relationship. This method is easy to apply and analyze, has a low cost and does not require the use of video or voice recorders during the session. Investigative studies on the pattern of relationship may provide further results on the adaptability of this instrument to our culture.

Keywords: Beziehungs-muster fragebogen, relationship patterns questionnaire, transference.

INTRODUCTION

Beziehungs-Muster Fragebogen (BeMus-3), known in the international literature as Relationship Patterns Questionnaire (RPQ),^1,2 is a questionnaire that assesses the main relationship standard and can, therefore, be used for assessing transference. The transference construct had its importance acknowledged since Sigmund Freud published his theory in 1905,³ in the postscript of "Dora's case." The author defined transference as new editions or facsimile of impulses and fantasies that are awaken and made conscious during the analysis process. Psychological experiences are lived again, but no longer towards the primitive characters of the past, but to the therapist in the current situation.

According to Freud,³ transference was an obstacle predestinated to psychoanalysis that, when detected and interpreted in patients, becomes their most powerful ally. In Five lessons on psycho-analysis, Freud theorized about the transference process. Expelled from consciousness and memory, the impulse still exists in the unconscious, waiting for an opportunity to reveal itself. There is the formation of a replacement of the repressed, to throw into consciousness something that also brings the feeling of displeasure that was thought to have been resolved by repression.

Melanie Klein⁵ also brought major contributions to this construct. She attributed the origin of transference to a moment before the one suggested by Freud. She considered transference as originating from the primitive object relationships, from the first relationships of children with the breast.

Freud⁶ stated that each individual develops a fast form of conducting themselves. This takes place through the combined activity of their innate disposition and influences in the first years and presents itself as a stereotypical cliché that is repeated along our lives.

Other authors are still contributing to this topic, which has never stopped being a current issue, since, as its discoverer said, if it is an instrument of cure, it is a daily instrument at work. Understanding it, therefore, can bring us closer to our patients, and possibly result in a better treatment prognosis.

In the PsycINFO database alone, we found 12,125 references about studies on this topic, from 1971 to July 2006. If we use the term transference as main keyword, there are 3,552 studies in that database, 1,073 empirical studies, 39 reviews of the literature, 10 qualitative studies, eight quantitative studies and others using different methodologies. The nature of the studies goes from purely psychoanalytical approaches to associations between the construct and psychiatric disorders.

In this context, the number of instruments available to measure the main relationship pattern or clichés repeated throughout life has been growing. We may classify these instruments into observational and self-reporting.

Among observational instruments, there are the following: Core Conflictual Relationship Theme (CCRT),⁷ Plan Formulation Method,⁸ Configurational Analysis Method,⁹ Frame Method,¹⁰ Cyclical Maladaptive Pattern Method,¹¹ Idiographic Conflict Formulation Method,¹² and Consensual Response Formulation Method.¹³

Among self-reporting measurements, we cite the INTREX Questionnaire,¹⁴ Central Relationship Questionnaire,¹⁵ and BeMus-3.^1,2

There are strong instruments, both observational and self-reporting, such as those mentioned in the two previous paragraphs. It is not our aim to compare both forms of assessing transference, due to its complexity, but we mention some advantages of self-reporting questionnaires. In general, they are instruments that have a low application and analysis cost, since they do not need a large number of people for assessment (judges), can be applied faster and are more objective.

BeMus-3 is a self-reporting questionnaire based on Benjamin's¹⁶ interpersonal model and on CCRT.⁷

In this study, we report the development of a Brazilian Portuguese version of this instrument, in its short form, to be used in exploratory investigation studies on the transference construct, some of which have already been carried out by our research team or are being concluded. The main objective is the introduction, in our country, of an instrument to assess transference that has a good theoretical support and whose application is compatible with our socioeconomic conditions.

INSTRUMENT DESCRIPTION

BeMus-3,^1,2 or RPQ in the international literature, is a questionnaire developed by Regina Kurth & Dan Pokorny, which was validated in 2002¹ and 2004.² It presents a long and short version. The development of its Brazilian Portuguese version, in this study, was performed for its short version.

It is a self-reporting questionnaire and can be applied to any reference person and at different times (present or childhood).

The items and scales in BeMus-3 have their theory based on Benjamin's¹⁶ interpersonal model, who developed the Structural Analysis of Social Behavior (SASB), with three focuses: transitive, intransitive and introject. The transitive one is the axis directed to the other. The intransitive one is directed to the subject itself. The introject one represents intrapsychic processes.

The SASB model is detailed, conceptually judicious and psychometrically advanced, descending from Leary's¹⁷ original model. The SASB allows the mathematical representation of interpersonal behaviors or their intrapsychic analogues as points in one of the three interrelated coordinates of two dimensions.¹⁸ Any interpersonal process can thus be mathematically described, locating it in one or more of SASB points. Similarly, differences and changes may also be quantified through the mathematical properties of this model.¹⁸

The BeMus-3 version used in this study corresponds to the further development of the BeMus-3 with eight unipolar scales: 1) Assert oneself; 2) Accept; 3) Love; 4) Rely on; 5) Submit; 6) Defend; 7) Attack; 8) Overlook. The short version, used in this study, presents four unipolar scales: 1) Assert oneself; 3) Love; 5) Submit; 7) Attack. According to Benjamin's¹⁶ model, those four scales are distributed into a bidimensional space with the axes of affiliation (love and attack) and interdependence (assert oneself and submit).

Therefore, BeMus-3 provides one score for each scale, in three different levels: self response (RS), object response (RO) and introject. The self level assesses the subject's response to a given behavior of another person (therapist, friend, son, mother, father, etc.); the object level assesses the subject's belief on another person's behavior, in response to a given behavior by himself; and the introject level assesses the subject's behavior after a confrontation with another person. The questionnaire, in its short form, is then structured in the following manner: 16 items, divided into four questions, assess RS; the next 16 items assess RO; and eight items assess the introject level. Each item is measured by a 5-point Likert scale. The score is obtained by the average of items related to the respective scale, and finally, the average is subtracted from an individual measurement value.

Therefore, BeMus-3 investigates the relationship standard based on the individual's response to another person's behavior (RS), what the individual believes is the other person's response to his behavior (RO), and how this individual acts after a confrontation with this person (introject level).

Until June 2006, there were five publications about this instrument in the PsycINFO database, whose focuses were on instrument validation;¹ introduction to two different applications of the instrument;¹⁹ psychometric properties of the instrument;² a quantitative approach for self-assessment of interpersonal standards;²⁰ validation study with a clinical sample.²¹ The construct validation was performed by checking the cyclic structures of scales and the cyclic order of its items. Scales were then correlated between themselves. The correlation force was dependent on the position in the interpersonal model. Adjacent scales were strongly positively correlated between themselves; more distant scales showed weaker positive correlations or negative correlations; and scales in opposite poles reached the maximum negative value. As to the cyclic order of the items, concordance coefficients for self and object levels of all items were satisfactory. Test/retest reliability of subject and object scales was also satisfactory.

This instrument was allowed to be used in this study by the authors Regina Kurth & Dan Pokorny through a cooperative study. Its psychometric profile, in the original version in German, described in the previous paragraph, suggested a reliable instrument, able to bring reliable results about transference relationship standards.

METHOD

The stages for the development of a Brazilian Portuguese version of BeMus-3 included the model proposed by Reichenheim et al.²² to obtain semantic equivalence, which consists of translation, back translation, formal appraisal of equivalence and interchange with the target population.

Obtaining permission from the authors

The contact with the first author, Regina Kurth, was initially made on November 2004, after the publication of a study on the psychometric properties of BeMus-3. There were successive contacts by e-mail, through which a cooperation study was arranged using this instrument. The instrument, in its long and short versions, was obtained, as well as permission to perform its translation.

Translation

It was performed based on the material in German, by an official translator, bilingual, fluent in German and Portuguese. The material obtained was revised by a psychology professional, fluent in German, who made the necessary adjustments along with a psychiatry professional.

Back translation

A professional German translator, fluent in Portuguese, performed this stage, without being aware of the original material in German, translated into Portuguese by the translator mentioned in the second item of the methodology.

Appraisal of semantic equivalence

It was carried out by the author of the instrument, Regina Kurth, who gave seven suggestions in the short back translated version. The team worked on the linguistic adjustments for the Brazilian Portuguese version. These were once again translated into German and sent back to the authors, until the semantic equivalence of the text was confirmed.

Consensus about the development of the Portuguese version

It was performed by 12 psychiatry and psychology professionals. The professionals were required to relate the content of each item to a scale of the interpersonal model, assessing aspects of content validity.

Interchange with the target population

The version of the instrument was then presented to 10 individuals of varied ages (between 18 and 60 years) and different schooling levels (elementary, high school and college), who filled in the scale and expressed their opinion on its understanding, assessing aspects of apparent validity.

RESULTS

Through the stages described in the methodology, a version into Brazilian Portuguese was obtained for the BeMus-3 instrument, used to assess the main relationship standard or transference standard.

After the back translation stage, in the appraisal of semantic equivalence, the authors of the instrument suggested some changes in seven terms of the questionnaire. The linguistic adjustments were performed by the research team and supervised by a professional translator, fluent in German and Portuguese.

In the consensus stage about the development of the Portuguese version of BeMus-3, performed by 12 psychiatry and psychology professionals, assessing the proper correlation between each item and the corresponding scale, there was 100% concordance in this correlation, coherent with the instrument proposal and therefore suggesting content validity.

In the interchange with the target population, the 10 patients who responded to the questionnaire did not present difficulties and considered the material understandable. Through a subjective appraisal on the meaning of each item, aspects of apparent validity were investigated. Any adjustment was needed after this last stage of the methodology.

The final version of BeMus-3 into Brazilian Portuguese also had the same format of the original instrument (^{appendix 1}).

DISCUSSION

Transference, which is a base construct in the research on psychoanalytical treatments, was defined by Freud in 1905³ as an agent of cure and resistance. Through it understanding, the therapist can identify the patient's impulses and fantasies towards primary characters and, consequently, the relationship standard used by the patient.

Hentschel²³ explains that the reduced number of exploratory studies, using empirical methodology, about aspects of the patient-therapist relationship is due to, among other factors, the therapists' disbelief about the capacity of available instruments to assess the therapeutic relationship. However, the author infers that changes in this scenario can already be seen, due to the increase in theoretically well-based scales.

Especially over the past three decades, a series of instruments has been developed to quantify the therapeutic relationship, i.e., to translate such understanding into numeric data, which can be assessed and provide statistically accepted results. Many methods, however, require several professionals; therefore, a longer period of time is necessary for application and analysis and, sometimes, a video or voice recorder is needed during the session.

Over the past years, self-reporting measurements have been developed to supply some difficulties found in observational methods. Nevertheless, it is important to stress that those comments do not aim at comparing the different method as to their ability of measuring the intended variables, since there are observational methods already established in the literature, with excellent theoretical references. They only aim at justifying the introduction of new instruments that may probably adapt well to our objectives.

BeMus-3 is a self-reporting questionnaire that has a low application cost and does not require the use of video or voice recorders during the session. The implementation of studies using this instrument will provide a better understanding about its real adaptability and functionality to assess transference in our country.

A major observation about this instrument is that it is still being developed in its original country and may suffer new adjustments over the following years.

The introduction of instruments to assess essential concepts, such as transference, is a support to research and can provide results to improve the quality of psychotherapeutic treatments.

CONCLUSIONS

Transference is a crucial concept for research in psychoanalysis and even in other areas in psychiatry. The number of studies investigating the relationship between transference and psychiatric disorders or between transference and attachment, for example, has been growing in the international literature. The introduction, in our country, of instruments develop to assess the transference standard may provide support for a better understanding of our patients, since this topic involves great part of their mental processes. BeMus-3 is a self-reporting instrument that is fast to apply and analyze. It has a low cost and presents good theoretical support.

When working with research instruments, one should know their advantages, applicability and limitations. Each research situation is a particular context, and generalizations can bring loses to the study, i.e., knowing what one wishes to investigate and searching for the measurement scale that best achieves the objectives are decisive steps to obtain reliable results.

The present version of BeMus-3 was performed and considered adequate by psychiatry and psychology professionals and understandable by the patients in the target population sample. Therefore, there is an available version of BeMus-3 developed into Brazilian Portuguese, observing the aspects of conceptual, item and semantic equivalence.

REFERENCES

Received August 1, 2006. Accepted December 11, 2006.

This study was carried out at Psychoanalytical Psychotherapy Program, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil. Based on a master's thesis by the first author, entitled "A study on the relationship between the transference standard and the therapeutic alliance in patients undergoing psychoanalytic psychotherapy," presented to Universidade Federal do Rio Grande do Sul in 2006.

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appendix 1

Publication Dates

• Publication in this collection
  04 Apr 2007
• Date of issue
  Dec 2006

History

• Accepted
  11 Dec 2006
• Received
  01 Aug 2006