Publications by authors named "Mariane Krause"

28 Publications

  • Page 1 of 1

Recognizing oneself in the encounter with others: Meaningful moments in systemic therapy for social anxiety disorder in the eyes of patients and their therapists after the end of therapy.

PLoS One 2021 11;16(5):e0250094. Epub 2021 May 11.

Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile.

Objective: The objective of this study is to characterize and describe meaningful moments in the context of systemic psychotherapy, from the point of view of patients and their therapists, after the end of therapy. The therapy studied is a manualized, monitored systemic therapy for social anxiety disorder.

Method: Semi-structured follow-up interviews were conducted separately with five patients and their therapists (N = 10). Methodological triangulation was used: Grounded theory was used to code the transcripts as described by Charmaz. Then the passages of the selected code "meaningful moment" were evaluated using thematic comparison, in line with Meuser & Nagel.

Findings: Three categories involving meaningful moments were identified: (1) meeting other patients in group therapy session, (2) therapeutic resource orientation and (3) recognizing oneself in a diagnosis or pattern of behaviour. These categories emerged as contexts related to the occurrence of meaningful moments from a subjective perspective.

Discussion: Meaningful moments seem to be consistently related to the therapist input and to specific interventions or settings, both from the perspective of the patients and the therapists. Two tandems each described a coincident moment. One central aspect of all 14 moments is that the patients and therapists described patients being able to acquire another outlook on themselves.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250094PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8112648PMC
May 2021

The therapeutic relationship in child psychotherapy: integrating the perspectives of children, parents and therapists.

Psychother Res 2021 Nov 28;31(8):988-1000. Epub 2021 Jan 28.

Psychology Department, Pontifical Catholic University of Chile, Santiago, Chile.

This study addresses the therapeutic relationship in child psychotherapy, through an exploration of the experience of the main actors engaged in child psychotherapy.

To describe and analyse the therapeutic relationship integrating the views of children, parents and therapists.

This study employs a qualitative methodology, assuming a discovery-oriented approach which draws from grounded theory. Twelve psychotherapy triads participated, composed of children aged 6-10, their parents and psychotherapists. Semi-structured follow-up interviews were conducted (N=36), including a drawing in the case of the children.

A positive therapeutic relationship with children and parents was viewed as a gradually constructed process, based on a positive emotional encounter between participants. It was facilitated primarily by the therapist's commitment and playful stance, the child and therapist mutual involvement, and the parent's collaboration. These aspects entailed a trustful, validating and caring relationship, that shaped children and parents' motivations towards therapy and facilitated change.

From a multiple-perspective approach, therapy was conceived as a relational experience. The development of positive relationships required different and evolving dispositions from therapy main actors. Therapists' genuine feelings and engagement in therapeutic activity seem central, underlining the importance of addressing relational aspects in child therapy research and training.
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http://dx.doi.org/10.1080/10503307.2021.1876946DOI Listing
November 2021

A Qualitative Study of a Mindfulness-Based Intervention in Educational Contexts in Chile: An Approach Based on Adolescents' Voices.

Int J Environ Res Public Health 2020 09 22;17(18). Epub 2020 Sep 22.

ANID, Millennium Science Initiative Program, Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 7820244, Chile.

The application of mindfulness-based interventions in school settings has increased considerably in recent years, showing that differences between the characteristics of programmes can impact on the receptivity and effectiveness of mindfulness training. However, few studies have explored the learning process from the perspective of the children and adolescents who participate in mindfulness practice. The goal of this paper is to analyse the subjective experience of a group of adolescents following the completion of a mindfulness-based intervention developed for schools in Chile. The intervention studied is the ".b curriculum", which is part of the Mindfulness in School Project (MiSP) developed in the UK. Twenty adolescents participated in semi-structured interviews within their school, in which three key areas were explored: pedagogy, perceived effects, and mechanisms of action, each of them being analysed from the perspective of thematic analysis. The results support the view that pedagogy is a very relevant consideration in the implementation, development, and efficacy of mindfulness-based interventions within the school context. We propose that the inclusion of structure, contents, process/mindful practices, and teachers' expertise provides the pedagogical-relational framework required for students to successfully develop mindfulness skills, which enables them to experience their cognitive, emotional, and somatic effects. These effects are linked to self-regulation strategies, based on paying attention to one's somatic experience with kindness and curiosity, which works as an attentional anchor. It is hoped that these results will contribute to the spread of mindfulness research in adolescents in Latin America, thus facilitating cross-cultural and international comparisons.
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http://dx.doi.org/10.3390/ijerph17186927DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558476PMC
September 2020

The relation between the therapeutic alliance and communicative intentions in therapeutic interaction during the initial phase of adolescent therapy.

Res Psychother 2019 Aug 30;22(2):356. Epub 2019 Jul 30.

Attachment and Emotional Regulation Center, Universidad del Desarrollo, Santiago.

This study aims to examine the connection between the therapeutic alliance (TA) - from both the patient's and the therapist's perspectives - and communicative intentions during the initial phase of adolescent psychotherapy. The sample comprised the first three sessions of 19 adolescents' individual psychotherapeutic processes. Fifty therapeutic conversation segments were analyzed, representing 2043 adolescent and 3208 therapist speaking turns. The variables studied were Therapeutic Alliance, measured with the Working Alliance Inventory and Communicative Intentions (Exploring, Attuning and Resignifying), assessed by the Therapeutic Activity Coding System. A multilevel analysis was performed (HLM software). The Tasks dimension of the TA perceived by the adolescents increases the likelihood that their discourse will focus on providing and requesting information (Exploring), while also reducing the probability that they will seek to work together with the therapist to achieve mutual understanding (Attuning). The therapists' discourse shows that a strong TA in the Bonds dimension makes it more probable for their utterances to focus on the construction of new meanings (Resignifying). Also, a stronger TA in the Goals dimension makes it more likely for their discourse to be directed toward seeking Attunement with the adolescent.
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http://dx.doi.org/10.4081/ripppo.2019.356DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451329PMC
August 2019

Trajectories of alliance ruptures in the psychotherapy of adolescents with borderline personality pathology: timing, typology and significance.

Res Psychother 2019 Aug 30;22(2):348. Epub 2019 Jul 30.

Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland.

Jeremy Safran and his research group suggest that rupture-repair processes are important for the therapeutic change in patients with personality disorders. In this exploratory study, we describe alliance ruptures and resolutions on a session-by-session basis in a clinical sample of adolescents with Borderline Personality Pathology (BPP). Three research questions are addressed: i) Is there a typical trajectory of alliance ruptures over treatment time? ii) Which rupture and resolution markers occur frequently? iii) Which rupture markers are most significant for the therapeutic alliance? Ten patients who presented with identity diffusion and at least three Borderline Personality Disorder criteria were studied and treated with Adolescent Identity Treatment. Alliance ruptures and resolutions were coded in 187 therapy sessions according to the Rupture Resolution Rating System. Mixed-effect models were used for statistical analyses. Findings supported an inverted U-shaped trajectory of alliance ruptures across treatment time. The inspection of individual trajectories displayed that alliance ruptures emerge non-linearly with particular significant alliance ruptures appearing in phases or single peak sessions. Withdrawal rupture markers emerged more often compared to confrontation markers. However, confrontation markers inflicted a higher impact or strain on the immediate collaboration between patient and therapist compared to withdrawal markers. Clinicians should expect alliance ruptures to occur frequently in the treatment of adolescents with BPP. The findings support the theory of a dynamic therapeutic alliance characterised by a continuous negotiation between patients and therapists.
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http://dx.doi.org/10.4081/ripppo.2019.348DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451373PMC
August 2019

A design for process-outcome psychotherapy research in adolescents with Borderline Personality Pathology.

Contemp Clin Trials Commun 2018 Dec 31;12:182-191. Epub 2018 Oct 31.

Child and Adolescent Psychiatric Hospital, Psychiatric Hospitals of the University of Basel, Basel, Switzerland.

Underage patients with Borderline Personality Pathology (BPP) are in need of specialised psychotherapeutic treatment. A handful of these treatments, including Adolescent Identity Treatment (AIT) and Dialectical Behavior Therapy for Adolescents (DBT-A), have been adapted for adolescent patients. Psychotherapy research has shown that the outcome of different psychotherapeutic approaches can be very similar despite conceptual and practical differences between the theoretical models. Therefore, to understand what really works in psychotherapy, it is necessary to investigate the psychotherapeutic process and its effects on the patient. This paper presents a study design for process-outcome research, integrating (1) a classical outcome design, comparing AIT and DBT-A in a non-inferiority trial assessing changes in psychosocial functioning at 12 months after baseline as primary outcome; and (2) a process research design, addressing multiple BPP and psychotherapy relevant factors. These factors include well-studied generic variables such as the psychotherapeutic alliance, more recent approaches such as video-based identification of significant therapeutic events, as well as more experimental approaches such as psychophysiological markers measured during the therapeutic sessions. The use of repeated measures and the methodological pluralism which includes event and micro-process analyses has been recommended for psychotherapy research aiming at a better understanding of the interplay of factors at work to narrow the gap between research and practice in this field.
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http://dx.doi.org/10.1016/j.conctc.2018.10.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251014PMC
December 2018

Introjective Individuals Tend Toward Anhedonia: Self-Report and Experimental Evidence.

Front Psychiatry 2018 5;9:298. Epub 2018 Jul 5.

Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago, Chile.

A broad line of research has conceptualized personality based on the interaction of two aspects: interpersonal relatedness and self-definition. This theoretical corpus understands these functions as two poles according to the patterns of interaction and relevance in personality. Additionally, the exacerbation of one of these poles generates a psychopathological model that identifies three types of depressive experience: anaclitic, introjective, or mixed pattern. Understanding the lack of interest as a key symptom of depression, this experiment evaluates a relation for anhedonia and the polarities model configuration using an empirical and experimental protocol. We tested 177 individuals using the Beck Depression Inventory (BDI) subscale for anhedonia and a visual discrimination task with a specific reward system, which was implemented to study reinforcement sensitivity. Participants were classified into four groups by the polarities of experience model. The subscale's results showed that individuals with an introjective character exhibited an enhanced anhedonic symptomatology but no co-occurrence of this evidence on the experimental protocol. These results empirically support the two polarities of the depressive personality model and raise new questions regarding how to experimentally test this relation.
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http://dx.doi.org/10.3389/fpsyt.2018.00298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6042048PMC
July 2018

[Psychometric properties of a spanish version of the Beck depression inventory IA].

Rev Med Chil 2017 Aug;145(8):1005-1012

Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago, Chile.

Background: According to the Chilean National Health Survey (2009-2010), 17% of people aged 15 years or more have depressive symptoms. Thus, freely-available, easily-administered, and highly sensitive screening tests for depression are needed in clinical and research settings.

Aim: To evaluate the psychometric properties of a Spanish version of the Beck Depression Inventory (BDI-IA) in adult Chilean population.

Material And Methods: The inventory was applied to a sample of 1.105 adults aged between 18 to 73 years (94% women). Ninety nine participants were outpatients receiving treatment for affective disorders, 932 were parents and/or guardians of students enrolled in schools and 73 were university students (sample with no known depressive disorder). To perform data analysis, two groups from the random combination of both samples were generated.

Results: The inventory showed an appropriate degree of internal consistency (Cronbach alpha = .92). An exploratory factor analysis suggested a one-factor solution. This solution was reinforced with a confirmatory factor analysis, which displayed an adequate goodness of fit. The cutoff score, based on the Youden Index, was 13/14 points. It was able to discriminate between depressed and non-depressed participants.

Conclusions: These results indicate that the BDI-IA is an appropriate instrument to assess depressive symptoms in Chilean adults.
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http://dx.doi.org/10.4067/s0034-98872017000801005DOI Listing
August 2017

Meeting in difference: Revisiting the therapeutic relationship based on patients' and therapists' experiences in several clinical contexts.

J Clin Psychol 2017 Nov 7;73(11):1510-1522. Epub 2017 Sep 7.

Pontificia Universidad Católica de Chile.

Despite decades of research on the therapeutic relationship and the therapeutic alliance and their connection with therapeutic outcomes (Horvath, Del Re, Flückiger, & Symonds, 2011), only a handful of studies have examined how they are experienced by the therapy participants. The aim of the present study is to describe the therapeutic relationship from the subjective perspective of the patients and therapists involved in 3 clinical cases: (a) a 7-year-old child diagnosed with attention deficit hyperactivity disorder, (b) a 29-year old woman diagnosed with a personality disorder, and (c) a 22-year-old man diagnosed with schizophrenia. We conducted semistructured interviews with patients and therapists that were later analyzed following grounded theory coding procedures (Corbin & Strauss, 2008). The results obtained reveal that the constitutive elements of the therapeutic relationship are linked to 2 dimensions of the patient-therapist meeting experience: the technical and role-related dimension, characterized by relational asymmetry, and the affective exchange dimension, characterized by relational symmetry. The article discusses the possible association between the asymmetrical technical dimension, whose roles are defined by the organization of the helping relationship, and the notion of therapeutic alliance as commonly conceptualized and assessed; on the other hand, the experience of the bidirectional and symmetrical patient-therapist affective exchange is linked with concepts such as real relationship and intersubjectivity.
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http://dx.doi.org/10.1002/jclp.22525DOI Listing
November 2017

Biological stress reactivity as an index of the two polarities of the experience model.

Psychoneuroendocrinology 2017 Oct 24;84:83-86. Epub 2017 Jun 24.

Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago, Chile.

The two-polarities model of personality argues that experience is organized around two axes: interpersonal relatedness and self-definition. Differential emphasis on one of these poles defines adaptive and pathological experiences, generating anaclitic or introjective tendencies. The anaclitic pattern, on one hand, has been conceptually related with an exaggerated emphasis on interpersonal relatedness. On the other hand, the introjective pattern has been connected to high levels of self-criticism. The aim of this study was to investigate the psychophysiological basis for this relationship. Specifically, we hypothesized that the anaclitic individual should have a higher biological reactivity to stress (BRS), measured by the cortisol concentration in saliva, in an interpersonal stress induction protocol (Trier Social Stress Test). Contrary to what was expected, the results indicated that introjective participants presented a higher BSR than the anaclitic group. Interestingly, in contrast to their higher BSR, the introjective group reported a diminished subjective stress in relation to the average. In the anaclitic group, a tendency that goes in the opposite direction was found. Theoretical implications of these findings were discussed.
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http://dx.doi.org/10.1016/j.psyneuen.2017.06.016DOI Listing
October 2017

Beyond Self-Criticism and Dependency: Structural Functioning of Depressive Patients and Its Treatment.

Res Psychother 2017 Apr 19;20(1):236. Epub 2017 Apr 19.

Psychology School, Pontificia Universidad Catolica de Chile, Santiago, Chile.

Van Praag states that the underlying psychic dysfunctions in psychopathology must be evaluated (and treated) in patient-centered treatments. In line with this idea, Blatt and colleagues propose the concept of self-critical (introjective) and dependent (anaclitic) functioning. The research program has studied self-critical and dependent functioning from different perspectives. The general aim of this paper is to share the results of the program that have contributed to clinical psychotherapeutic thinking. Its first specific aim is to summarize results reported elsewhere that support the predictive value of introjective and anaclitic functioning (Part I), while its second specific aim is to report original data that account for the structural functioning of personality underlying these two constructs (Part II). The results (Part I) show that self-critical functioning is associated with greater reactivity to stress (according to cortisol level in stress tasks) and less subjective awareness of stress, reduced performance in general tasks, and lower mentalization (errors in faces); also, patients with introjective (self-critical) depression receiving psychotherapy have more symptoms at onset, higher dropout rates, and poorer response to interventions than anaclitic (dependent) patients. Higher self-criticism was associated with higher depression scores; also, when comparing clinical and nonclinical samples, the latter showed less self-criticism. Therefore, self-critical functioning represents a challenge for researchers and clinicians. The evaluation of the structural functioning of personality showed (Part II) that self-critical functioning is associated with less integrated levels of structure and more depressive symptoms. This functioning is underlain by vulnerabilities in the abilities and Dependent functioning is associated with vulnerabilities in , and The psychotherapeutic implications of these results are discussed, paying special attention to aspects connected with structure-oriented psychotherapy
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http://dx.doi.org/10.4081/ripppo.2017.236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451298PMC
April 2017

Depression and Attachment: How do Personality Styles and Social Support Influence This Relation?

Res Psychother 2017 Apr 13;20(1):237. Epub 2017 Apr 13.

Psychology School, Pontificia Universidad Catolica de Chile, Santiago.

The purpose of this study is to improve the current understanding of the relation between depression and attachment through the evaluation of the role of personality styles (dependent self-critical) and social support in this association. These variables were studied in a clinical sample of 70 depressed outpatients (83% women; M=41.47 years, SD=12.91). Depressive symptomatology was assessed through the Beck Depression Inventory, adult attachment through the Experiences in Close Relationships Scale, social support through the Social Support Questionnaire and dependency and self-criticism through the Depressive Experiences Questionnaire. Mediational and moderation regression analyses were performed. Results show that the association between the dimensions of attachment (anxiety and avoidance) and depression was partially mediated by self-criticism. Furthermore, results demonstrate the role of social support as a moderating variable: when the level of satisfaction with social support was low and the anxiety dimension in the attachment scale was high, as avoidance increased, depressive symptoms increased as well. Results are discussed in relation to their importance for understanding the complex interplay of the variables involved in depression.
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http://dx.doi.org/10.4081/ripppo.2017.237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451375PMC
April 2017

Role of Personality Functioning in the Quality of Life of Patients with Depression.

J Nerv Ment Dis 2017 09;205(9):705-713

*Faculty of Social Sciences, School of Psychology, Pontificia Universidad Católica de Chile, Macul; and †Faculty of Medicine and ‡Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.

Depression is associated with reduced quality of life (QoL), and personality pathology is associated with higher impairment and poorer treatment outcomes in patients with depression. This study aims to analyze the effects of personality functioning on the QoL of patients with depression. Severity of depressive symptoms (Beck Depression Inventory), level of personality functioning (Operationalized Psychodynamic Diagnosis Structure Questionnaire), and QoL (Medical Outcome Study 36-item Short-Form) were assessed in a sample of 84 depressive outpatients. Personality functioning showed main effects on both the mental and physical components of QoL. A moderating effect of personality functioning on the relationship between depressive symptoms and QoL was tested but not confirmed. Severity of depressive symptoms was found to mediate the effect of personality functioning on the mental component of QoL. These results suggest that the effect of personality functioning on the QoL of patients with depression may be related to the higher severity of depressive symptoms found in patients with lower levels of personality functioning.
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http://dx.doi.org/10.1097/NMD.0000000000000676DOI Listing
September 2017

Disentangling the change-alliance relationship: Observational assessment of the therapeutic alliance during change and stuck episodes.

Psychother Res 2017 09 21;27(5):595-607. Epub 2016 Apr 21.

e Department of Psychology , Simon Fraser University , Burnaby , Canada.

The therapeutic alliance is considered the most robust process variable associated with positive therapeutic outcome in a variety of psychotherapeutic models [Alexander, L. B., & Luborsky, L. (1986). The Penn Helping Alliance Scales. In L. S. Greenberg & W. M. Pinsoff (Eds.), The psychotherapeutic process: A research handbook (pp. 325-356). New York: Guilford Press; Horvath, A. O., Gaston, L., & Luborsky, L. (1993). The alliance as predictor of benefits of counseling and therapy. In N. Miller, L. Luborsky, J. Barber, & J. P. Docherty (Eds.), Psychodynamic treatment research: A handbook for clinical practice (pp. 247-274). New York, NY: Basic Books; Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48, 9-16; Orlinky, D., Grawe, K., & Parks, B. (1994). Process and outcome in psychotherapy: Noch einmal. In A. Bergin & J. S. Garfield (Eds.), Handbook of psychotherapy and behaviour change (4th ed., pp. 270-378). New York, NY: Wiley and Sons]. The relationship between alliance and outcome has traditionally been studied based on measures that assess these therapy factors at a global level. However, the specific variations of the alliance process and their association with therapy segments that are relevant for change have not yet been fully examined. The present study examines the variations in the therapeutic alliance in 73 significant in-session events: 35 change and 38 stuck episodes identified through the observation of 14 short-term therapies of different theoretical orientations. Variations in the alliance were assessed using the VTAS-SF [Shelef, K., & Diamond, G. (2008). Short form of the revised Vanderbilt Therapeutic Alliance Scale: Development, reliability, and validity. Psychotherapy Research, 18, 433-443]. Nested analyses (HLM) indicate a statistically significant better quality of the alliance during change episodes.
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http://dx.doi.org/10.1080/10503307.2016.1147657DOI Listing
September 2017

Acceptability Study of "Ascenso": An Online Program for Monitoring and Supporting Patients with Depression in Chile.

Telemed J E Health 2016 07 7;22(7):577-83. Epub 2016 Jan 7.

1 Department of Psychology, Pontificia Universidad Católica de Chile , Santiago, Chile .

Background: Major depression is a highly prevalent and severe mental disease. Despite the effective treatment options available, the risk of relapse is high. Interventions based on information and communication technologies generate innovative opportunities to provide support to patients after they completed treatment for depression.

Materials And Methods: This acceptability study evaluated the Internet-based program Apoyo, Seguimiento y Cuidado de Enfermedades a partir de Sistemas Operativos (ASCENSO) in terms of its feasibility and acceptability in a sample of 35 patients in Chile.

Results: The study reveals high rates of acceptance and satisfaction among patients who actively used the program. As obstacles, patients mentioned technical problems, a lack of contact with other participants, and an insufficient connection between the program and the health service professionals.

Conclusions: ASCENSO appears to be a promising complement to regular care for depression. Following improvements of the program based on participants' feedback, future research should evaluate its efficacy and cost-effectiveness.
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http://dx.doi.org/10.1089/tmj.2015.0124DOI Listing
July 2016

[Barriers restricting postpartum depression treatment in Chile].

Rev Med Chil 2015 Apr;143(4):424-32

Background: In Chile, postpartum depression is a prevalent and disabling condition. Universal screening is available but has not been translated into better treatment rates, suggesting the existence of access barriers.

Aim: To describe access barriers to postpartum depression treatment in six primary health care clinics in Metropolitan Santiago, Chile.

Material And Methods: Twenty women with postpartum depression and 18 primary health care professionals were subjected to a semi-structured interview. A qualitative methodology based on Grounded Theory was used.

Results: There are user associated barriers such as lack of knowledge about the disease, a negative conceptualization and rejection of available treatment options. There are also barriers associated with poor network support and some features of the health care system such as long waiting times and lack of coordination between clinical and administrative decisions.

Conclusions: Patient and provider related barriers restricting treatment of postpartum depression were identified.
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http://dx.doi.org/10.4067/S0034-98872015000400002DOI Listing
April 2015

Discourse-voice regulatory strategies in the psychotherapeutic interaction: a state-space dynamics analysis.

Front Psychol 2015 16;6:378. Epub 2015 Apr 16.

Psychology, Pontificia Universidad Católica de Chile Santiago, Chile.

This study seeks to provide evidence of the dynamics associated with the configurations of discourse-voice regulatory strategies in patient-therapist interactions in relevant episodes within psychotherapeutic sessions. Its central assumption is that discourses manifest themselves differently in terms of their prosodic characteristics according to their regulatory functions in a system of interactions. The association between discourse and vocal quality in patients and therapists was analyzed in a sample of 153 relevant episodes taken from 164 sessions of five psychotherapies using the state space grid (SSG) method, a graphical tool based on the dynamic systems theory (DST). The results showed eight recurrent and stable discourse-voice regulatory strategies of the patients and three of the therapists. Also, four specific groups of these discourse-voice strategies were identified. The latter were interpreted as regulatory configurations, that is to say, as emergent self-organized groups of discourse-voice regulatory strategies constituting specific interactional systems. Both regulatory strategies and their configurations differed between two types of relevant episodes: Change Episodes and Rupture Episodes. As a whole, these results support the assumption that speaking and listening, as dimensions of the interaction that takes place during therapeutic conversation, occur at different levels. The study not only shows that these dimensions are dependent on each other, but also that they function as a complex and dynamic whole in therapeutic dialog, generating relational offers which allow the patient and the therapist to regulate each other and shape the psychotherapeutic process that characterizes each type of relevant episode.
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http://dx.doi.org/10.3389/fpsyg.2015.00378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4399330PMC
May 2015

Using decision trees to characterize verbal communication during change and stuck episodes in the therapeutic process.

Front Psychol 2015 9;6:379. Epub 2015 Apr 9.

Department of Management Control and Information Systems, Universidad de Chile Santiago, Chile.

Methods are needed for creating models to characterize verbal communication between therapists and their patients that are suitable for teaching purposes without losing analytical potential. A technique meeting these twin requirements is proposed that uses decision trees to identify both change and stuck episodes in therapist-patient communication. Three decision tree algorithms (C4.5, NBTree, and REPTree) are applied to the problem of characterizing verbal responses into change and stuck episodes in the therapeutic process. The data for the problem is derived from a corpus of 8 successful individual therapy sessions with 1760 speaking turns in a psychodynamic context. The decision tree model that performed best was generated by the C4.5 algorithm. It delivered 15 rules characterizing the verbal communication in the two types of episodes. Decision trees are a promising technique for analyzing verbal communication during significant therapy events and have much potential for use in teaching practice on changes in therapeutic communication. The development of pedagogical methods using decision trees can support the transmission of academic knowledge to therapeutic practice.
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http://dx.doi.org/10.3389/fpsyg.2015.00379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391223PMC
April 2015

Generic change indicators in therapeutic processes with different outcomes.

Psychother Res 2015 14;25(5):533-45. Epub 2014 Jul 14.

a Department of Psychology , Pontificia Universidad Católica de Chile , Santiago , Chile.

Objectives: This paper analyzes the relationship between ongoing change and final outcome in therapies carried out in natural settings with 39 clients.

Method: Ongoing change was assessed through generic change indicators (GCIs), an observational method designed to label the content of change moments by selecting one specific GCI from the sequence of 19 that covers from more rudimentary and low complexity to more elaborated and complex changes. These GCIs can also be grouped into three broad stages of change, according to their level of complexity. Productivity indicators were generated to account for the number of GCIs (total and grouped by stage) adjusted by the length of therapy and the respective individual production of GCIs. Outcome, in turn, is understood as the final result of therapy and was measured by Lambert's Outcome Questionnaire (OQ 45.2).

Results: Using the Reliable Change Index of this measure, which qualifies the difference between initial and final scores, therapies were grouped into "good outcome" and "poor outcome" cases. Findings indicate that therapies with good final outcome show a greater presence of Stage III GCIs during the process. Furthermore, in these therapies there is a significant association between Stage I GCI productivity and the productivity of Stages II and III GCIs. This is not the case for poor outcome cases, where results show a greater productivity of initial stage GCIs, mostly in the second half of therapy and no relation of this productivity with Stage II and Stage III GCIs.

Conclusions: Results support the relation of ongoing change and final outcome. Possibilities for the clinical use of GCIs, specifically for monitoring ongoing therapies, are discussed.
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http://dx.doi.org/10.1080/10503307.2014.935516DOI Listing
March 2016

The sound of change: a study of the psychotherapeutic process embodied in vocal expression. Laura Rice's ideas revisited.

Psychother Res 2015 18;25(2):263-76. Epub 2014 Mar 18.

a Department of Psychology , Universidad de Los Andes , Santiago , Chile.

Objective: The purposes of this article were to compare the characteristics of the vocal quality of therapists and patients in change and stuck episodes, and to depict patient-therapist interaction sequences of vocal properties, in order to analyze micro-regulatory processes within the psychotherapeutic interaction.

Method: Application of the Vocal Quality Patterns coding system to a study of a sample of change and stuck episodes, taken from six psychotherapies.

Results: The results made it possible to show that the 15 psychotherapeutic change process are embodied in the modes of vocal expression of their participants, and that the way in which these different modes are coordinated within the interaction makes it possible to observe regulatory micro-sequences that participate in the therapeutic change process.
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http://dx.doi.org/10.1080/10503307.2014.892647DOI Listing
October 2015

[Medium-term effect of an intervention program for adolescent mothers].

Aten Primaria 2013 Mar 13;45(3):157-64. Epub 2012 Dec 13.

Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile.

Objective: To analyze the medium-term results of an experimental study which evaluates the effects of home visits by para-professionals to a sample of adolescent mothers, which was successful in the short-term.

Design: Quantitative, follow up of two cohorts. FIELD OF STUDY: Two health centers in low socioeconomic areas, Santiago, Chile.

Participants: From a sample of 104 adolescent mothers and their children, 69 were contacted when their sons or daughters were 48 month old. Lost data was about 33.6%.

Interventions: Outcomes variables were: mental health of the mothers; their social, work, and family integration; their interaction with the child; and language and socio-emotional development of the child. The independent variable was the intervention: home visiting. PRINCIPAL MEASUREMENT: The short-term evaluation in the experimental and control groups was carried out using standardized questionnaires when the children were between 12 and 15 months old, and the medium-term evaluation at the age of 48 months.

Results: The short term positive effects on the mental health of the mother and on language development of the child were not sustained in the medium-term. The only positive effect was the stability in the relationship with their partners.

Conclusions: On the basis of these results, the importance of maintaining regular visits, in order to prevent the fading of the initial effects, is discussed.
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http://dx.doi.org/10.1016/j.aprim.2012.09.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6985502PMC
March 2013

[Effectiveness of a home visit program for adolescent mothers and their children].

Rev Med Chil 2011 Jan 11;139(1):60-5. Epub 2011 Apr 11.

Facultad de Ciencias Sociales/Escuela de Psicología, Escuelas de Medicina y Enfermería, Facultad de Medicina, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Santiago, Chile.

Background: Home visiting is effective for the promotion and prevention of mother-child health in other countries, especially in vulnerable populations such as pregnant teenagers.

Aim: To evaluate the association between receiving a home visiting program during pregnancy and child development during the first year of life, maternal mental health, perception of social support and school attendance.

Material And Methods: Cross sectional assessment of 132 teenage mother-sibling pairs. Of these, 87 received home visits and 45 were randomly assigned to a control group. The assessed variables were maternal mental health, perception of social support, life satisfaction, incorporation of mothers to school after delivery, child development and frequency of child abuse and neglect.

Results: Mothers that received home visits had a better mental health and went back to school in a higher proportion. No significant differences between groups were observed on perception of social support or child development.

Conclusions: These results suggest the effectiveness of domiciliary visits performed by non-professionals, to improve mental health and social integration of teenage mothers.
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http://dx.doi.org//S0034-98872011000100008DOI Listing
January 2011

Clients', therapists', and observers' agreement on the amount, temporal location, and content of psychotherapeutic change and its relation to outcome.

Psychother Res 2010 Jul;20(4):472-87

Department of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile.

Clients', therapists', and observers' identification of change was studied in 27 therapeutic processes, and agreement on the amount, temporal location, and content of change was related to outcome. Results show that clients reported more changes in successful therapies. Client-therapist temporal match of change moments was low irrespective of outcome. Results from all three perspectives were consistent in that manifestation of new behaviors and emotions was the most representative content of change among all therapies. Meanwhile, client-therapist agreement on the frequency of grouped change indicators reported was associated with positive outcome, whereas client-observer agreement was related to negative outcome. Therapists and observers agreed in both successful and nonsuccessful therapies. The relationship between agreement and therapeutic outcome is discussed in relation to each dimension of analysis.
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http://dx.doi.org/10.1080/10503301003705871DOI Listing
July 2010

Analysis of verbalized emotions in the psychotherapeutic dialogue during change episodes.

Psychother Res 2010 Mar;20(2):136-50

Department of Psychology, Pontificia Universidad Catolica de Chile, Santiago, Chile.

As described by many theorists, emotional expressions contribute to the activation and regulation of personal emotional experiences and communicate something about internal states and intentions. These emotional expressions can be observed in the words used in our speech and nonverbal behaviors, even when nonverbal behaviors are synchronized to one's own speech or to the speech of others. Using a quantitative and qualitative methodology, this article reports a classification of verbal emotional expressions of both psychotherapists and patients in change episodes. Assuming that the emotions loaded in linguistic contents are explicit emotions shown by emotion words, this methodology allows for a complete and differentiating assessment of affective qualities in both patients and psychotherapists during the psychotherapeutic dialogue.
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http://dx.doi.org/10.1080/10503300903170921DOI Listing
March 2010

A cost-effectiveness evaluation of a home visit program for adolescent mothers.

J Health Psychol 2009 Oct;14(7):878-87

Pontificia Universidad Católica de Chile, Macul, Santiago de Chile.

A home visit intervention program for adolescents throughout their pregnancy and during the early stages of motherhood was evaluated. The participants (N = 90) were part of a larger group of adolescents treated in two health centers in a poor neighborhood in Santiago, Chile. The program was carried out by volunteer community health monitors and evaluated through an experimental, randomized, controlled clinical trial. Cost-effectiveness was examined in comparison with standard health care. Results show higher scores for the intervention group on the mothers' mental health and nutritional state, as well as on the children's levels of linguistic development.
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http://dx.doi.org/10.1177/1359105309340988DOI Listing
October 2009

Language and therapeutic change: a speech acts analysis.

Psychother Res 2008 May;18(3):355-62

Department of Psychology, Pontificia Universidad Catolica de Chile, Santiago, Chile.

Drawing on the speech acts theory, a linguistic pattern was identified that could be expected to be associated to therapeutic change, characterized by being uttered in the first person singular and present indicative, and by being self-referential in its propositional content. The frequency of the pattern was examined among verbalizations defined as change moments in three therapies with different theoretical orientation. Results show that the majority of change moments have the specified pattern, and that this pattern is significantly more frequent in change moments than in random non-change-related verbalizations, and so, it does not pertain to therapeutic conversation in general. Implications are discussed concerning the possibility of using the linguistic pattern as an additional and complementary criterion in the identification of moments of change in the therapeutic process.
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http://dx.doi.org/10.1080/10503300701576360DOI Listing
May 2008

The transformation of social representations of chronic disease in a self-help group.

Authors:
Mariane Krause

J Health Psychol 2003 Sep;8(5):599-615

The Psychology School of the Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile.

A Participant Action Research process was carried out with individuals affected by Inflammatory Bowel Disease, more specifically Crohn's Disease and Ulcerative Colitis. The results show evidence of a transformation of social representations of disease. 'Normalization' is the central component of the transformation, indicating the achievement of a more restricted representation of the illness. This change is an attitudinal modification, which is characterized by higher tolerance of the disease--accepting its chronic nature and the limitations it imposes on daily life--, acceptance of the possibility of being supported by others in facing the disease, and the recognition of a transformational process that involves different stages in dealing with and accepting the disease.
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http://dx.doi.org/10.1177/13591053030085010DOI Listing
September 2003

The institutionalization of community interventions in Chile: characteristics and contradictions.

Authors:
Mariane Krause

Am J Community Psychol 2002 Aug;30(4):547-70

Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago.

A critical analysis of the consequences of successive institutionalization of community intervention in Chile is presented. This analysis is based on research of current community interventions in Chile, whose results are compared with Chilean community practice from previous historical periods. Chilean community intervention was formerly practiced out of governmental institutions and universities and was sustained primarily by foreign agencies and ecclesiastical institutions. Nowadays, with the return to democracy, the vast majority of community intervention programs arefinanced, partially or totally, by means of governmental resources. This institutionalization of community interventions has had consequences worthy of critical analysis: an increase in the number and stability of intervention programs; and also negative consequences for intervention goals definition of target groups, and intervention practices. Dilemmas, such as assistance vs. promotion or adaptation vs. social change, have arisen. These dilemmas show the contradictions of a Community Psychology, which has left behind the position of institutional marginality to form part of Chilean society's "normal" psychosocial care. They also show the need for a paradigm shift from a "critical" view of the social world to a constructionist one.
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http://dx.doi.org/10.1023/A:1015812118935DOI Listing
August 2002
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