[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to investigate the construct validity of the Assessment of Countertransference Scale (ACS) in the context of the trauma care, through the identification of the underlying latent constructs of the measured items and their homogeneity.
ACS assesses 23 feelings of CT in three factors: closeness, rejection and indifference. ACS was applied to 50 residents in psychiatry after the first appointment with 131 victims of trauma consecutively selected during 4 years. ACS was analyzed by exploratory (EFA) and confirmatory (CFA) factor analysis, internal consistence and convergent-discriminant validity. RESULTS In spite of the fact that closeness items obtained the highest scores, the EFA showed that the factor rejection (24% of variance, α = 0.88) presented a more consistent intercorrelation of the items, followed by closeness (15% of variance, α = 0.82) and, a distinct factor, sadness (9% of variance, α = 0.72). Thus, a modified version was proposed. In the comparison between the original and the proposed version, CFA detected better goodness-of-fit indexes for the proposed version (GFI = 0.797, TLI = 0.867, CFI = 0.885 vs. GFI = 0.824, TLI = 0.904, CFI = 0.918).
ACS is a promising instrument for assessing CT feelings, making it valid to access during the care of trauma victims.
Revista Brasileira de Psiquiatria 06/2012; 34(2):201-6. DOI:10.1590/S1516-44462012000200013 · 1.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the association between feelings of countertransference (CT) at the early psychiatric care provided to trauma victims and treatment outcome.
The Assessment of Countertransference Scale was used to access CT after the first medical appointment. Fifty psychiatric residents cared for 131 trauma victims of whom 83% were women, aged 15 to 64 years. Patients had been consecutively selected over 4 years. Were evaluated the clinical and demographic characteristics of patients and the correlation with the therapists' CT feelings. Patients were followed-up during treatment to verify the association between initial CT and treatment outcome, defined as discharge and dropout.
The median number of appointments was 5 [4; 8], absences 1 [0; 1], and the dropout rate was 34.4%. Both groups, namely the discharge group and the dropout group, shared similar clinical and demographic characteristics. A multivariate analysis identified that patients with a reported history of childhood trauma were 61% less likely to dropout from treatment than patients with no reported history of childhood trauma (OR = 0.39, p = 0.039, CI95% 0.16-0.95). There was no association between initial CT and treatment outcome.
In this sample, CT in the initial care of trauma victims was not associated with treatment outcome. Further studies should assess changes in CT during treatment, and how such changes impact treatment outcome.
Revista Brasileira de Psiquiatria 12/2011; 33(4):379-84. DOI:10.1590/S1516-44462011000400012 · 1.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To identify demographic and clinical correlates associated with therapists' countertransference feelings on the first visit of women victims of sexual violence.
Forty patients were seen by 26 therapists, during 2 consecutive years, at the Center for the Study and Treatment of Psychological Trauma, Hospital de Clínicas de Porto Alegre , Brazil. After the first visit with the patient, the therapist completed the Assessment of Countertransference Scale and the patient was evaluated with the Davidson Trauma Scale, the Standardized Assessment of Personality - Abbreviated Scale, the Beck Depression Inventory, and the Defense Style Questionnaire.
The therapists showed a predominance of feelings of closeness (Mean = 5.42, SD = 1.25) in relation to the feelings of indifference (Mean = 1.82, SD = 1.22) and distance (Mean = 1.57, SD = 1.08) [p < 0.001]. Multivariate analyses did not present significant associations between countertransference feelings and clinical characteristics of patients. The gender of the therapists did not influence the pattern of countertransference feelings. In the subgroup of female therapists, we detected an inverse correlation between a higher probability of patients' personality disorders and feelings of closeness in the therapists.
We did not detect a differential pattern of countertransference feelings associated with specific clinical characteristics. Therapists of both genders presented a similar pattern of feelings of empathy towards women victims of sexual violence, although the gender of the therapist may moderate the feelings evoked by patients with increased likelihood of personality disorders.
Revista Brasileira de Psiquiatria 03/2011; 33(1):16-22. DOI:10.1590/S1516-44462010005000019 · 1.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Brain-derived neurotrophic factor (BDNF) has an important role in learning, motivation and regulation of mood. The aim of this study was to investigate levels of serum BDNF in patients with trauma psychopathology (acute and post-traumatic stress disorder) when compared to age and gender matched controls.
A consecutive sample of 34 patients was evaluated regarding socio-demographic and clinical variables by means of a standard protocol, Davidson Trauma Scale, Beck Depression Inventory, Clinical Global Impression and the Global Assessment of Functioning. BDNF serum levels were measured right after the intake interview.
Patients had higher BDNF levels than controls. Those levels, however, were higher right after the traumatic event, decreasing over time. When two groups of patients (recent and remote trauma) were investigated in separate, the recent trauma group (less than 1year since the traumatic event) had higher BDNF than controls, but this effect was not detected in the remote trauma group. The recent and remote trauma groups had different BDNF levels. Those findings persisted, even controlling for symptom severity, use of psychotropic medication, and history of psychiatric disease.
As far as we know this is the first report of elevated serum BDNF levels in patients with recent trauma. Based in animal models that implicate BDNF in memory formation and consolidation, higher BDNF in recent PTSD could be related to memory and learning disruption central in PTSD psychopathology.
Progress in Neuro-Psychopharmacology and Biological Psychiatry 04/2010; 34(3):459-62. DOI:10.1016/j.pnpbp.2010.01.010 · 3.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate brain-derived neurotrophic factor levels in two patients, one with posttraumatic stress disorder and one with acute stress disorder, before and after treatment, and to compare those levels to those of healthy controls.
Brain-derived neurotrophic factor level, Davidson Trauma Scale, Beck Depression Inventory, Global Assessment of Functioning, and Clinical Global Impression were assessed before and after 6 weeks of treatment.
Brain-derived neurotrophic factor levels were higher in patients than in matched controls before treatment. After 6 weeks, there was a reduction in symptoms and an improvement in functioning in both cases. At the same time, brain-derived neurotrophic factor levels decreased after treatment, even in case 2, treated with psychotherapy only.
These results suggest that serum levels of brain-derived neurotrophic factor, as opposed to what has been described in mood disorders, are increased in posttraumatic stress disorder as well as in acute stress disorder.
Revista Brasileira de Psiquiatria 04/2009; 31(1):48-51. DOI:10.1590/S1516-44462009000100012 · 1.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Parental Bonding Instrument (PBI) is a widely used measure of parenting. Recent studies have proposed different factor structures. There is a disagreement in the literature about whether the PBI is best used as a two-factor or a three-factor measure.
Two hundred and fifty-seven female adults were recruited from a clinical population (139 psychiatric patients and 118 controls) and were requested to complete the PBI. Maximum likelihood confirmatory factor analyses were performed to compare the five different factor structures in terms of model fit.
The poorest fit to the data was obtained by the Parker et al. model. The Kendler model was the only model that had an adjusted goodness-of-fit index >0.8 regarding both paternal and maternal PBI. When considering invariance of factor structure across age subgroups, the Kendler model was also the only acceptable model.
Three-factor structures are preferable to two-factor structures. The Kendler model was the only one to provide an acceptable fit, but it must be considered that it was a female sample, and when considering gender subgroups other studies have found the same results. Despite the gender limitation, the present study contributes to a better understanding and use of the PBI in Brazilian samples.
Australian and New Zealand Journal of Psychiatry 04/2009; 43(4):348-54. DOI:10.1080/00048670902721053 · 3.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The study aims to compare the mental states and countertransference responses of 92 psychodynamically oriented psychotherapists, male and female, experienced and inexperienced, facing written reports of real patients who experienced traumatic events. Two vignettes were presented: one of a sexual violence, the other the sudden death of a significant person. The Mental States Rating System (MSRS; Bouchard, Picard, Audet, Brisson, & Carrier, 1998), the MSRS Self-Report (Goldfeld & Bouchard, 2004), and the Inventory of Countertransference Behavior (ICB; Friedman & Gelso, 2000) were used. Results showed that the mourning vignette led to more reflective responses (MSRS) and the rape case was associated with more negative countertransference reactions (ICB). Female participants were more reflective (MSRS); male therapists used less mentalized states (MSRS Self-Report) and expressed more negative reactions (ICB) for both scenarios. Experienced therapists showed more positive reactions on the ICB. The construct validity of the instruments is discussed in relation to the findings.
Psychotherapy Research 09/2008; 18(5):523-34. DOI:10.1080/10503300801968640 · 1.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The authors discuss the term ‘analytic process’, confi rming the variability of the meanings ascribed to it. Although all the psychoanalysts of this and previous times acknowledge the existence of something called analytic process, as well as its importance, it has not been possible up to now to establish a consensual defi nition of it. The defi nitions are not only numberless, they also contradict one another. The possible advantages to analytic theory and practice proceeding from a uniform concept are incontrovertible. A review of the subject in the psychoanalytic literature has been performed. A conceptual study concerning the term, carried out among members of a psychoanalytic society affi liated to the IPA is presented, no consensual conceptualization for the term analytic process having been found. The subjects referred to the term as deriving from a variety of elements, some in common, but there was no agreement regarding the elements themselves. There was consensus regarding the role of the analytical relationship in the process, considered fundamental, as well as that of the extent to which the individual life experiences in that relationship defi ne the unique character acquired by the process within it.
The International Journal of Psychoanalysis 06/2008; 87(2):403 - 422. DOI:10.1516/F9W2-TK0W-WJGX-0BQQ · 0.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: INTRODUÇÃO: O artigo apresenta a adaptação transcultural do Mental States Rating System, uma escala de análise de conteúdo do discurso, seja ele falado, descrito ou filmado, que abrange de modo amplo tipos de contratransferência. MÉTODO: Foram realizadas as etapas de equivalência conceitual, equivalência de itens, equivalência semântica, equivalência operacional, equivalência funcional e aprovação da versão final pelo autor original do instrumento. RESULTADOS: Os critérios de equivalência foram satisfeitos, tendo a versão final sido aprovada pelo autor do instrumento original. CONCLUSÃO: A adaptação do Mental States Rating System disponibiliza para uso um instrumento que não só abrange todas as categorias de contratransferência descritas na literatura, mas as amplia, através da Teoria dos Estados Mentais. Constitui, desse modo, uma ferramenta de grande utilidade para pesquisa em psicoterapia e psicanálise, onde a contratransferência tem se mostrado um importante recurso, tornando-se ainda mais crucial nas patologias fundamentadas em estágios precoces do desenvolvimento, nos casos graves e nos traumas severos.
Revista de Psiquiatria do Rio Grande do Sul 04/2008; 30(1):59-64. DOI:10.1590/S0101-81082008000100012
[Show abstract][Hide abstract] ABSTRACT: Introduction: The quality of a therapeutic alliance is essential in psychoanalytic psychotherapy and influences the therapeutic process. This study evaluated the relationship between the level of defense mechanisms and the quality of therapeutic alliance established during psychotherapy. Method: Patients in psychotherapy and their respective therapists completed the Helping Alliance Questionnaire (patient version and therapist version, respectively). The level of defenses was inferred by the Defensive Functioning Scale proposed in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision. Results: There was no association between the quality of therapeutic alliance and the patient's level of defense mechanisms in this sample. On the other hand, there was a difference when the therapist version was compared to the patient version: patients established a stronger therapeutic alliance in relation to their therapists. Conclusion: The lack of influence of defense level in the quality of therapeutic alliance suggests that the therapist's training and personal characteristics may lead to the ability of connecting with the patient, despite impairment in their psychic functioning.
Revista de Psiquiatria do Rio Grande do Sul 01/2008; 30(2). DOI:10.1590/S0101-81082008000300006
[Show abstract][Hide abstract] ABSTRACT: OBJETIVO: Avaliar a contratransferência dos terapeutas durante o atendimento inicial de pacientes mulheres vítimas de violência sexual e urbana, investigando a influência do gênero do terapeuta e da natureza e momento do trauma. MÉTODO: A amostra foi composta por 36 relatos redigidos por médicos residentes de psiquiatria do Hospital de Clínicas de Porto Alegre, oriundos do atendimento de 36 pacientes. Este estudo utilizou métodos qualitativos e quantitativos para a análise dos seus dados. Os relatos foram classificados em seis grupos, conforme o gênero do terapeuta e a natureza do trauma. Foi realizada a análise de conteúdo dos relatos. Associou-se uma análise estatística dos dados. RESULTADOS: Houve predomínio de sentimentos de aproximação nos terapeutas de ambos os sexos no atendimento de vítimas de violência sexual. Entre terapeutas mulheres, a natureza do trauma (sexual ou urbano) não influenciou os padrões contratransferenciais (p = 0,7). Entre os terapeutas homens, ao contrário, a natureza do trauma influenciou de forma significativa (p = 0,044) o padrão contratransferencial, havendo um número elevado de sentimentos de distanciamento nos relatos de atendimentos de vítimas de violência urbana. CONCLUSÕES: Houve um predomínio de sentimentos de aproximação dos terapeutas de ambos os sexos no atendimento inicial de pacientes vítimas de violência sexual. Foi observado um predomínio de sentimentos de distanciamento nos terapeutas homens que atenderam vítimas de violência urbana. Mais estudos são necessários para uma melhor compreensão das relações terapêuticas nos atendimentos de vítimas de trauma psíquico.
Revista de Psiquiatria do Rio Grande do Sul 08/2007; 29(2):197-204.
[Show abstract][Hide abstract] ABSTRACT: Objective: To assess therapists' countertransference during initial care of female victims of sexual and urban violence with the aim of investigating influence of therapist's gender, type and moment of trauma. Methods: The sample comprised 36 reports written by psychiatry residents at Hospital de Clínicas de Porto Alegre based on the care provided to 36 patients. This study used qualitative and quantitative methods of data analysis. Reports were classified into six groups according to therapist's gender and type of trauma. A content analysis and a statistical analysis of the data were performed.
Revista de Psiquiatria do Rio Grande do Sul 08/2007; 29(2). DOI:10.1590/S0101-81082007000200011
[Show abstract][Hide abstract] ABSTRACT: OBJETIVO: O artigo apresenta a adaptação transcultural do Inventory of Countertransference Behavior (ICB) para o português brasileiro. O ICB constituise numa escala de 21 itens que busca acessar o comportamento contratransferencial. Esta escala, que deve ser preenchida pelo supervisor após a sessão de supervisão, abrange a contratransferência em suas categorias positiva e negativa. MÉTODO: Foram realizadas as etapas de equivalência conceitual, equivalência de itens, equivalência semântica, equivalência operacional, equivalência funcional e aprovação da versão final pelo autor original do instrumento. RESULTADOS: Os critérios de equivalência foram satisfeitos, tendo a versão final sido aprovada pelo autor do instrumento original. CONCLUSÃO: A adaptação do ICB disponibiliza para uso um instrumento de utilização prática, que abrange as categorias de contratransferência positiva e negativa. Constitui, deste modo, uma ferramenta de grande utilidade para a clínica, a supervisão e a pesquisa em psicoterapia e psicanálise, onde a contratransferência tem se mostrado um importante recurso, especialmente no tratamento de patologias fundamentadas em estágios precoces do desenvolvimento, nos casos graves e nos traumas severos.
Revista de Psiquiatria do Rio Grande do Sul 04/2007; 29(1):56-62. DOI:10.1590/S0101-81082007000100012
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to examine the impact of parental bonding as a resilience or a risk factor for psychopathology after rape. Women rape victims were assessed regarding the perception of parental bonding in childhood, acute posttraumatic stress disorder symptoms, acute stress disorder (ASD), and clinical severity. The perception of having less affective parents was correlated with severity, and ASD was more frequent in participants with less affectionate and more controlling fathers. Perceived support was associated with clinical impairment. These findings could help in identifying those who need early interventions and highlight the importance of social and emotional support in facing traumatic situations, reinforcing aspects of the parent–child relationship that generate adults more apt to face adverse situations.
Psychotherapy Research 01/2007; 17(1):83-90. DOI:10.1080/10503300500477596 · 1.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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.
Revista de Psiquiatria do Rio Grande do Sul 12/2006; 28(3):276-288.
[Show abstract][Hide abstract] ABSTRACT: O objetivo deste artigo é revisar aspectos importantes da relação entre a contratransferência e o atendimento de pacientes vítimas de trauma psíquico. O tratamento de pessoas traumatizadas é potencialmente uma fonte de sofrimento psíquico também para os terapeutas, devido à grande carga emocional envolvida, bem como pelas chances de evocar fortes reações contratransferenciais. Um maior entendimento acerca deste processo poderá contribuir decisivamente para os resultados dos tratamentos, além de possibilitar a proteção e a prevenção da saúde mental dos terapeutas. Inicialmente, aborda-se o trauma a partir de seu conceito e definições, incluindo considerações sobre o transtorno de estresse pós-traumático, estendendo-se para a conceitualização de contratransferência e seu significado no contexto das situações traumáticas. O impacto de tratar pacientes vítimas de trauma será também exposto através da relevância do fenômeno de traumatização vicária, cuja compreensão vem sendo destacada como indispensável para um melhor atendimento de vítimas de traumas psicológicos.
Revista de Psiquiatria do Rio Grande do Sul 12/2006; 28(3):314-320.
[Show abstract][Hide abstract] ABSTRACT: OBJETIVO: O artigo apresenta a adaptação transcultural do Parental Bonding Instrument, um questionário auto-aplicável desenvolvido em 1979 e usado desde então para avaliar a percepção da qualidade do vínculo com os pais até os 16 anos. MÉTODO: Foram realizadas as etapas de equivalência conceitual, equivalência dos itens, equivalência semântica, equivalência operacional, equivalência funcional e aprovação da versão final pelo autor original do instrumento. RESULTADOS: Os critérios de equivalência foram satisfeitos, tendo a versão final sido aprovada pelo autor do instrumento original. CONCLUSÃO: A adaptação do Parental Bonding Instrument disponibiliza para uso um instrumento que já demonstrou ser extremamente útil em pesquisas de risco e resiliência nas últimas décadas, ao avaliar a percepção de características do comportamento dos pais tradicionalmente associadas ao desenvolvimento da personalidade.
Revista de Psiquiatria do Rio Grande do Sul 08/2006; 28(2):162-168. DOI:10.1590/S0101-81082006000200008
[Show abstract][Hide abstract] ABSTRACT: The authors discuss the term 'analytic process', confirming the variability of the meanings ascribed to it. Although all the psychoanalysts of this and previous times acknowledge the existence of something called analytic process, as well as its importance, it has not been possible up to now to establish a consensual definition of it. The definitions are not only numberless, they also contradict one another. The possible advantages to analytic theory and practice proceeding from a uniform concept are incontrovertible. A review of the subject in the psychoanalytic literature has been performed. A conceptual study concerning the term, carried out among members of a psychoanalytic society affiliated to the IPA is presented, no consensual conceptualization for the term analytic process having been found. The subjects referred to the term as deriving from a variety of elements, some in common, but there was no agreement regarding the elements themselves. There was consensus regarding the role of the analytical relationship in the process, considered fundamental, as well as that of the extent to which the individual life experiences in that relationship de?ne the unique character acquired by the process within it.
The International Journal of Psychoanalysis 05/2006; 87(Pt 2):403-22. · 0.86 Impact Factor