The purpose of this study was to analyse the therapeutic process of a case of couple therapy for depression. The evolution of symptoms, marital satisfaction and therapeutic alliance were evaluated during therapy. Results showed that symptoms followed a specific trajectory where the patient displayed a sudden deterioration towards the end of their therapy but, at follow-up, reached a clinically significant change in both individual and relational measures. The analysis of the process highlighted the association between the couple’s relational pattern and its problematic within-system alliance, as well as the relevance of this association for explaining the trajectory of change. The most useful case management interventions were: (a) fostering a relational formulation of symptoms; and (b) the use of therapy termination as an intervention. Results from this case study support the role of relational mechanisms for the process of change and provide technical alternatives that can be applied in cases at risk of failure.
The purpose of this study was to explore the content of personal constructs in people diagnosed with bulimia nervosa (BN). We expected to find differences in the predominant content of the construct systems between women with and without BN. We analyzed the constructs elicited using the repertory grid technique from 120 women aged between 18 to 45 years, divided into two groups: a clinical group of women diagnosed with bulimia (n = 62) and a control group of university students (n = 58). The constructs were categorized using the Classification System for Personal Constructs (CSPC), composed of six themes which are broken down into 45 categories. For this study, a new area called “Physical” was included, and it consists of three categories. The results indicated that women diagnosed with bulimia used significantly more constructs related to the body, while the control group used more constructs from the personal area. In addition, the congruent constructs from the clinical sample were predominantly moral, or related to values and interests, while discrepant constructs were personal and physical. The findings provide evidence for the clinical use of the CSPC as an instrument for exploring the content of personal meaning systems. Understanding the patient’s personal constructions about herself and others is useful for treatment. Moreover, it is important for clinicians to explore the content of constructs related to symptomatic areas, which could be hindering change, and focus on them to facilitate improvement.
El modelo narrativo - temático, sobre el que se articula el presente trabajo, es un intento de síntesis y desarrollo de otros dos modelos terapéuticos con los que comparte premisas: la terapia narrativa y la terapia dialógica. Algunos de los instrumentos que propone el modelo, ejemplificados a través de un caso clínico, ponen de relieve las principales diferencias con estas terapias: qué posición asume el terapeuta, cuál es el locus de intervención, a qué y quién responde la conversación terapéutica y qué objetivo tiene la terapia. Este modelo plantea una forma particular de uso del equipo que permita a los integrantes zafarse de cómo la historia que cuentan (las familias y los profesionales) condiciona sus respuestas. Teniendo en cuenta el flujo de conversaciones que preceden a la conversación terapéutica, el Plan Temático de la Sesión se plantea como una herramienta que permite al equipo situarse en la red y ayudar así a reposicionar a la familia apuntando a posibilidades y a futuro. La conversación terapéutica busca influir sobre las relaciones entre los miembros de la familia y los profesionales con los que se van a seguir relacionando. Para ello se tiene en cuenta qué personas y qué temas se activan en un momento determinado en el sistema, así como qué sesgo van tomando las conversaciones. La historia que interesa es la que se pueda construir a partir de lo que le ocurre a la familia mientras transcurre la terapia, lo que denominamos la historia por vivir.
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