Interaction structures in the psychodynamic psychotherapy of a patient with chronic diseases and somatic symptoms.

Fernanda Barcellos Serralta,Carolina Stopinski Padoan,Simone Hauck,Pricilla Braga Laskoski,Stefania Pigatto Teche,Cláudio Laks Eizirik,Alcina Juliana Soares Barros

doi:10.1590/2237-6089-2017-0146

Abstract

This study aimed to identify and analyze the interaction structures (ISs) (patterns of reciprocal interaction between the patient-therapist dyad) that characterize the process of a successful long-term psychodynamic psychotherapy (28 months) of a patient with chronic diseases (lupus and fibromyalgia) and somatic symptoms. The 113 sessions were videotaped and analyzed alternately (n = 60) by independent judges using the Psychotherapy Process Q-Set. Inter-rater reliability ranged from 0.60 to 0.90, with a mean of r = 0.71 (Pearson's correlation). Through a principal component exploratory factor analysis, four ISs were identified. The patterns of interaction between patient and therapist showed clinical validity (i.e., they were easily interpretable in the context of the case under study). The ISs were non-linear and more or less prominent across different treatment sessions and stages. Some ISs were similar to those in other studies, and others were probably unique to the present process. In addition, some ISs were independent, whereas others were interrelated over time. Process studies, such as the present one, seek to address questions about the characteristics of the interaction between patient and therapist as well as to identify particular patterns of interaction that are most prominent with a specific patient at a specific condition or time. Therefore, these studies can provide some support in establishing knowledge for clinical practice, assisting in the training of therapists, as well as in the elaboration of general guidelines for the technical management of patients with specific characteristics.

Highlights

Over the last few decades, significant advances in psychotherapy research have been made, in the field of outcome research
The present study identified four interaction structures (ISs) between a patient with chronic diseases, cluster C traits and somatic symptom disorder and an experienced therapist during treatment
It verified that some detected ISs were independent, whereas others were interrelated over time

Summary

Introduction

Over the last few decades, significant advances in psychotherapy research have been made, in the field of outcome research. Xv, 16), which are manifested as a part of the transferencecountertransference matrix.[7] From this, he developed a theory of therapeutic action (from psychoanalysis and PDT) that combines the effects of both insight and patient-therapist relationship on treatment outcomes, either facilitating or hindering therapeutic progress. In other words, he proposed that neither insight nor relationship alone will lead to changes in PDT. The IS theory of therapeutic action has been consistent with other findings and research, suggesting that common and unique factors most likely work symbiotically (and sometimes parasitically) with one another and are likely to be present and potentially relevant in any given psychotherapy.[8]

Methods

Results

Conclusion