The primary aim of this study is to improve our understanding of therapists' experience of a "difficult patient" and consider the different variables involved in this label. What makes a patient be perceived as difficult by a therapist in public health services? Results of our analysis of 10 qualitative semistructured interviews of therapists working in public health service in Chile indicated that therapists' perceptions of a "difficult patient" depend on variables that go beyond the patient's intrinsic characteristics, including patients' negative attitude toward the therapist and treating team, patients' negative effects on therapists, and a difficult treatment context (e.g., work overload, scarce resources, limited number, and frequency of sessions). We illustrate the interaction of these dimensions and focus on the impact of the treating context on therapists' experience of a "difficult patient" through the case of a therapist working with a patient with complex depression in the public health system of Chile.
Poor outcomes and several complaints to the judicial system against residential services for children have triggered a deep review of the Chilean child welfare services, particularly in relation to family reunification. This paper offers strategic guidelines to improve alternative care for children younger than six years of age, who are under protective measures. To define such guidelines, a case study was developed based on current models of residential services and foster home programs, which included local (Chile) and international evidence; also this research includes original empirical data collected through focus groups and interviews with key stakeholders of these programs in Chile and in two countries with advanced social services for children (Sweden and Italy). Findings refer to a structural need for reforming social services for Chilean children. Such reform should involve appropriate legislation to guarantee the rights of children and families; a substantial budgetary review leading to an increase in spending; and boosting professional specialization; and raising the capacity for offering integrated services.
Este artículo presenta información relevante para profesionales de la salud mental que trabajarán con pacientes adultos con trastorno por estrés post-traumático (TEPT) en las postrimerías de un desastre de origen natural y que no poseen entrenamiento especializado en modalidades expertas para el manejo de TEPT. El artículo presenta orientaciones a partir de una revisión de diferentes guías internacionales para el trabajo con pacientes con TEPT y la revisión de la literatura científica internacional relevante. Estas orientaciones fueron revisadas por un panel de expertos chilenos. El resultado, el cual se presenta en este artículo, es una serie de orientaciones prácticas orientadas a aquellos psicoterapeutas que trabajarán con pacientes con TEPT tras la ocurrencia de un desastre de origen natural. Se presentan viñetas clínicas para ejemplificar algunas de las orientaciones. Palabras clave: desastres de origen natural, estrés post-traumático, psicoterapia, orientaciones This article presents information relevant to mental health professionals who work with adult patients with posttraumatic stress disorder (PTSD) in the aftermath of natural disasters and who lack specialized training in evidencebased treatments for PTSD. The article presents orientations based on a review of several international guidelines for working with patients with PTSD and the relevant international scientific literature. These guidelines were reviewed by a panel of Chilean experts. The result, which is presented in this article, consists in a series of practical guidelines aimed at psychotherapists who must work with patients with PTSD after natural disasters. Clinical vignettes are presented to exemplify some of these guidelines.
The empirical status of empirically supported psychotherapies: Assumptions, findings, and reporting in controlled clinical trials. Psychological Bulletin 130:631-663. ---& SHEDLER, J. (1999). Revising and assessing Axis II: II. Toward an empirically based and clinically useful classification of personality disorders.
Objective The article examines the role of family income on the relationship between change in symptomatic burden and change in life satisfaction during six sessions of naturalistically delivered individual psychotherapy. Method Five hundred and thirty‐two clients receiving psychotherapy were assessed at baseline and on a session‐to‐session basis with the OQ‐30.2 and with a life satisfaction questionnaire. Data were analysed using a bivariate latent class model with structured residuals that included cross‐lagged and autoregressive components between residual scores at each time point. Adjusted family income and a binary low versus high‐income group variable were added as exogenous baseline covariates at different stages of the analyses. Results Regardless of income level, clients show improvement in psychological distress and life satisfaction as a function of time during treatment. Initial levels and improvement in life satisfaction are related to initial levels and improvement in psychological distress, and lower family income is related to slower decreases in psychological distress. When the whole sample is analysed, psychological distress and life satisfaction show reciprocal prospective relationships at the within‐person level. When models are estimated by income group, casual relationships at the within‐person level vary as a function of income. Conclusion Family income level appears to play a significant role in the relationship between symptom improvement and life satisfaction during psychotherapy.
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