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The present study analyzed 10 completed and successful therapeutic processes using a mixed methodology. The therapies were video-and audio-taped, as well as observed through a one-way mirror by trained observers. The findings suggest that anaclitic patients tend to use more verbalizations in order to ask for feedback or to be understood by their therapists attune , whereas introjective patients tend to use more verbalizations in order to construct new meanings resignify during therapeutic conversation, but especially during SEs.
Clinical implications to enrich the therapeutic practice are discussed. If therapeutic action were separated from specific schools, and studied in generic terms, seeking those shared by the different therapeutic approaches and modes, it would be possible to assess their actual contribution to the construction of the patient's change in therapeutic interaction. Based on the assumption that human beings do not act as a result of what things are, but according to their own representation of them, studying the way patients speak may lead to a better understanding of the subjective meanings cognitive, affective, evaluative, and behavioral that they ascribe to themselves and the relationship with their surroundings.
Experts have developed systems to classify both patient and therapist verbalizations. In addition, some of these systems have been constructed upon the basis of a specific therapeutic approach, or to analyze a particular therapeutic issue.
Systems for the Classification of Psychotherapeutic Dialogue. Text analysis is one of the systems developed to determine multiple psychological dimensions based on people's speech. Bearing this in mind, verbal expressions are analyzed using a process-based approach that leads to understanding therapeutic change as a change in meanings, that is to say, as a representational modification.
Such associations are fostered during segments of the session considered significant or relevant for change according to certain criteria, and are also expressed at a communicative level during therapeutic conversation. According to Blatt , , personality development involves the achievement of a differentiated and consolidated identity; yet, it is also necessary to develop stable, enduring, and mutually satisfying interpersonal relationships.
Extensive research has been conducted showing important differences between anaclitic and introjective personality, thus demonstrating the validity of diagnosing both configurations to understand a wide range of psychopathology, specifically within depression and personality disorders.
Furthermore, anaclitic and introjective configurations involve a different experiential mode and behavioral orientation, with very different types of gratification and preferred modes of cognition, defense, and adaptation. Therefore, each group of patients is expected to experience the psychotherapeutic process differently, which may be reflected in their speech.
The distinction between anaclitic and introjective personality derives primarily from psychodynamic considerations, including differences in instinctual focus libidinal vs. However, the development of the self is neglected and defined primarily in terms of the quality of interpersonal experiences; thus, these individuals are very dependent and vulnerable to experiences of abandonment.
Relatedness refers to feelings of loss, sadness, and loneliness in reaction to the disruption of relationships. These feelings are not undifferentiated and nonspecific; rather, they reflect concerns about the loss of a special person to whom one feels attached. Dependence refers to feelings of helplessness, fear, and apprehension about separation and rejection, and intense and broad-ranging concerns about a general loss of contact with others, unrelated to a particular relationship.
These items reflect a desperate need for others but with little differentiation or specification of any particular person or relationship. The primary preoccupation with self-definition in these configurations distorts the quality of interpersonal experiences, which makes these individuals very vulnerable to feelings of failure, criticism, and guilt.
These individuals tend to use counteractive rather than avoidant defenses including isolation, doing and undoing, intellectualization, reaction formation, introjection, identification with the aggressor, and overcompensation in an effort to preserve a consolidated sense of self.
Regardless of the therapeutic approach used and the course of the therapy, both groups of patients display different contents of therapeutic change. For example, introjective patients change primarily in terms of the frequency of their clinical symptoms as well as the level of their cognitive functioning; therefore, psychotherapeutic changes occur more slowly and more subtly in anaclitic patients, who express those changes primarily through the quality of their interpersonal relationships. Such findings suggest that these two personality configurations might also have divergent responses to different therapeutic intervention forms, or to each of the phases of the therapeutic process.
Based on a performative view of language Reyes et al. Some of these episodes were related to the process of co-construction of new meanings with therapists, while others were associated with a temporary halting of the patient's change process due to a reemergence of the problem. The aim of the present study was to identify the presence of verbal micromarkers in the speech of patients, depending on episode type, phase of the therapeutic process, and symptomatology.
The present study was guided by the following hypotheses:. Hypothesis 2: introjective patients resignify more than anaclitic patients, while the latter use more verbalizations in order to attune. Hypothesis 3: anaclitic patients focus their work on contents referred to a third party, compared to introjective patients.
Hypothesis 4: both anxious and depressive patients work on affective contents throughout the therapeutic process; however, depressive patients do it more extensively during the final phase compared to anxious patients. Hypothesis 5: the resignification of contents is higher during the final phase of therapy, compared with the initial phase. Hypothesis 6: introjective patients resignify more cognitive contents, while anaclitic patients resignify more contents referred to themselves.
Ten therapies conducted in Chilean private therapeutic centers were analyzed see Table 2. All the therapies are part of the Therapeutic Processes Database provided by the Chilean Millennium Nucleus Project, which has generated audiovisual recordings over the last years with the purpose of conducting process analysis.
The therapies were intentionally selected according to the following criteria: a therapies with a weekly individual modality, b therapists with 10 to 30 years of professional experience, c therapies with a significant degree of change as well as an evolution of change throughout the process, and d participants who gave their informed consent to participate in the study. Characteristics of Therapeutic Processes. Therapeutic outcome. Therapeutic outcomes were estimated using the Outcome Questionnaire OQ The List of Generic Change Indicators was used to estimate the evolution of therapeutic change Krause et al.
The consolidation of the structure of the therapeutic relationship Level I was more frequent during the initial stages of the process, while both patients were capable of constructing and consolidating a new way of understanding themselves at the end of the process Level III. Classification of the therapies according to the predominant symptoms. Ten therapies met the above-mentioned requirements; however, the next step was to classify them according to the predominant symptoms, regardless of the reasons for consulting.
This Observation Guideline initially includes an item which captures the existence of criteria related to psychotic disorders, substance-related disorders, dementia and other cognitive disorders, mental retardation, and antisocial personality disorder. However, it does not claim to diagnose a depressive or any other mood disorder; instead, it is used for capturing the presence or absence of depressive symptoms Salvo et al. The presence of depressive symptoms was approved if one of the first two items was answered affirmatively.
However, if the temporal requirement of a minimum of two weeks was also met in all the observed criteria, the observer was able to diagnose a Major Depression according to the DSM-IV-TR.
A diagnostic examination based on the first two video-taped sessions of the 10 included therapies was conducted by three observers with at least five years of clinical experience, in order to identify those patients who were seeking psychotherapeutic help due to the predominance of depressive symptoms. The reliability study was carried out in the following three successive stages: a two observers individually coded each item of the Observation Guideline; b they discussed their coding in order to reconcile their differences and to make a final decision about the presence or absence of depressive symptoms in each patient.
If necessary, they additionally watched a part of the videos or read the transcriptions again to reach a consensus based on the data; and c this last coding was compared again with the assessment of a third observer, who rated the therapy sessions following the same principles and procedure mentioned above. The degree of agreement for coding each item of the guideline was calculated using the Cohen's kappa between the joint judgment of the first two observers and the judgment of a third observer.
The degree of agreement varied from moderate to perfect in ten of the items, showing no significant effects only in items four? However, the items which most directly reflect the main criteria and the final diagnostic conclusion for depressive symptoms showed a moderate to high degree of agreement between the observers. According to the first part of the guideline, the total sample was distributed as follows: 6 patients with a predominance of depressive symptoms and 4 patients with a predominance of anxious symptoms see Table 3.
Classification of patients according to their depressive personality styles. Additionally, the Observation Guideline developed has a second part to differentiate the predominance of one of the following depressive personality styles: Anaclitic, Introjective and Mixed.
These styles were proposed by Blatt in , as a result of psychoanalytic theoretical formulations and clinical observation of depressive patients. Research has shown that the concepts of dependency and self-criticism are closely related to these styles: for example, the symptomatology of depressed patients reveals few differences among them, but these depressive styles are much more effective in highlighting variation.
A depressed patient with an Anaclitic personality style is characterized by deep feelings of loss and loneliness, while a depressed patient with an Introjective personality style is characterized by intense feelings of worthlessness Blatt, Therefore, according to the second part of the Observation Guideline, the total sample was distributed as follows: 6 anaclitic patients and 4 introjective patients see Table 3.
Demarcation of change and stuck episodes. The ten videotaped therapies were observed by expert raters trained in the use of a protocol for detecting and identifying relevant moments during therapeutic sessions Krause et al.
All the sessions were listed in chronological order and transcribed to facilitate the subsequent delimitation of the Change Episodes CE and Stuck Episodes SE. As shown in Figure 1 , the moment of change marks the end of the CE. Said moment of change must meet the criteria of theoretical correspondence, novelty, topicality, and consistency; that is, they must match one of the indicators from the Hierarchical List of Change Indicators GCI; Krause et al.
Afterwards, using a thematic criterion, the beginning of the therapeutic interaction referring to the change moment is tracked in order to define the start of the CE.
In the case of SEs, it was necessary to identify those periods of the session in which there was a temporary halting of the patient's change process due to a reissue of the problem, that is, episodes of the session characterized by a lack of progressive construction of new meanings Herrera et al.
A SE must also match one of the topics from the List of Stuck Topics, occur during the session, and be nonverbally consistent with the topic of that kind of episode. In addition, a SE must comply with the following methodological criterion: be at least three minutes long and be at least 10 minutes apart from a CE in the same session. All the sessions of each therapy were considered in order to transcribe, delimit, and analyze all the CEs and SEs identified see Table 3.
Specifically, 50 episodes included in sessions were analyzed. Moreover, each speaking turn was divided into speech segments — the sampling unit — depending on the presence of two or more Communicative Intentions coded within a single speaking turn see Figure 2. Segmentation of speaking turns. According to the TACS Characteristics of communicative actions.
Verbalizations were termed Communicative Actions, because they have the double purpose of conveying information Contents and exerting an influence on the other participant and the reality constructed by both speakers Action.
This system is based on a performative view of language, and was developed in order to reveal the complexity and multidimensionality of communicative interaction in psychotherapy see Figure 3. Dimensions and categories of the Therapeutic Activity Coding System, version 1. The TACS The categories that include the 22 Action codes are: Basic Form formal structure of the utterance , Communicative Intention communicative purpose expressed during the utterance , and Technique methodological resources present in the utterance, some of which coincide with therapeutic techniques, while others are typical of everyday interaction.
On the other hand, the categories that include the 9 Content codes are: Domain cognitive, affective, or behavioral and Reference protagonist of the object of therapeutic work. A second reliability analysis was carried out to evaluate the degree of agreement between the coders of the speech segments included in the CEs and the SEs. The resulting code configuration of each speech segment was analyzed.
In other words, two CPs can have the same characteristics at the Structural Level, but, at the same time, they can be articulated differently depending on the circumstances present in a given moment of the conversation, which does not affect their structure.
For example, a patient could use the CP in order to explore second digit, 1 affective contents third digit, 3 using an assertion as formal structure first digit, 2 , but also these contents are referred to herself fourth digit, 1 and uses argumentations to support the communicative intention present in this speech segment fifth-sixth digits, Therefore, the hypotheses advanced in this study involve a three-level hierarchy.
The highest level Level-3 contains the patient-related variables, such as symptomatology and personality style see Figure 4. Episode-related variables are situated at the middle level of the hierarchy Level Level-2 variables are nested within and impacted by Level Speech segment-related variables, such as verbalizations with the presence of specific CAs or CPs are situated at the lowest level Level The Level-1 predicted variables are nested within and impacted by the Level-2 predictor variables.
In HLM, the outcome variable of interest is always situated at the lowest level of the hierarchy. For example, patients verbalize specific communicative actions Level-1 during Change Episodes Level-2 depending on their personality style Level The first category of the TACS Patients are more likely to use verbalizations with agreement e.
However, the opposite occurs with the use of assertions e.
55504870 Metodo De Klapp Y Niederhoffer
Qu es el mtodo Klapp? Los ejercicios Klapp se fundamentan en la movilizan de la columna vertebral a partir de la posicin de cuatro puntos o tetrapodia. A estas posiciones iniciales se asocian dos tipos de ejercicios, la de ambulacin y los estiramientos. Para ello Klapp utiliza seis posiciones que pueden adoptarse en cifosis en lordosis. La columna dorsal superior desde D1 hasta D4 puede ser movilizada electivamente en lordosis.
Ejercicios de Columna
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