Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-18T20:29:27.840Z Has data issue: false hasContentIssue false
  • English
  • Français

¿Se explican las relaciones terapéuticas en psiquiatría por los síntomas de los pacientes? Factores que influyen en las evaluaciones de los pacientes

Published online by Cambridge University Press:  12 May 2020

R. McCabe  and
S. Priebe
R. McCabe
Affiliation:
Unidad de Psiquiatría Social y Comunitaria, Barts, Facultad de Medicina de Londres, Centro Newham para la Salud Mental, LondresE13 8SP, Reino Unido
S. Priebe
Affiliation:
Unidad de Psiquiatría Social y Comunitaria, Barts, Facultad de Medicina de Londres, Centro Newham para la Salud Mental, LondresE13 8SP, Reino Unido
Get access

Resumen

Objetivo

Investigar la relación terapéutica y cómo influyen en ella los factores sociodemográficos y clínicos.

Método

Este estudio analizó las autoevaluaciones de la relación terapéutica en 90 pacientes de primera admisión, 72 pacientes hospitalizados a largo plazo y 41 pacientes ambulatorios con esquizofrenia, junto con 249 pacientes alcohólicos y 42 depresivos hospitalizados, y su asociación con variables sociodemográficas y clínicas. En todos los pacientes, la relación terapéutica se evaluó utilizando una escala simple basada en tres elementos.

Resultados

La relación terapéutica difería significativamente a través de los grupos. La evaluaron más positivamente los pacientes alcohólicos y menos positivamente los pacientes con esquizofrenia hospitalizados a largo plazo. El aumento de manifestaciones psicopatológicas evaluadas por observador se asociaba significativamente con una relación terapéutica peor en todos los grupos, excepto los pacientes de esquizofrenia hospitalizados. En este grupo, el aumento de los síntomas autoevaluados se asoció con una relación peor. En los análisis de regresión múltiple, el 3-28% de la varianza de la relación se explicaba por las manifestaciones psicopatológicas.

Conclusiones

Las evaluaciones de los pacientes de la relación terapéutica se explicaban en parte por las manifestaciones psicopatológicas, dejando la mayor parte de la varianza para que la expliquen otros factores que las características sociodemográficas y clínicas.

Keywords

Relaciones profesional-pacienteEvaluaciónPsiquiatríaManifestaciones psicopatológicasRelación terapéutica
Type
Artículo Original
Information
European Psychiatry (Ed. Española) , Volume 10 , Issue 8 , November 2003 , pp. 519 - 526
Copyright
Copyright © European Psychiatric Association 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bibliografía

Clarkin, JF, Hurt, SW, Crilly, JL.Therapeutic alliance and hospital treatment outcome. Hos Community Psychiatry 1987; 38: 871–5.Google ScholarPubMed
Cohén, J.Statistical power analysis for the behavioral sciences. Hillsdale: NJ: Lawrence Erlbaum Associates; 1988.Google Scholar
Draine, J, Solomon R Case manager alliance with clients in an older cohort. Community Ment Health J 1996; 32: 125–34.CrossRefGoogle Scholar
Frank, AF, Gunderson, JG.The role of the therapeutic alliance in the treatment of schizophrenia. Arch Gen Psychiatry 1990; 47: 228–36.CrossRefGoogle ScholarPubMed
Gastón, L, Thompson, L, Gallagher, D, Cournoyer, L, Gagnon, R.Alliance, technique, and their interactions in predicting outcome of behavioural, cognitive, and brief dynamic therapy. Psychother Res 1998; 8: 190–209.CrossRefGoogle Scholar
Hansson, L, Berglund, M.Stability of therapeutic alliance and its relationship to outcome in short-term inpatient psychiatric care. Scand J Soc Med 1992; 20: 45–50.CrossRefGoogle ScholarPubMed
Hoffmann, K, Isermann, M, Kaiser, W, Priebe, S.Quality of life in the course of deinstitutionalisation—Part IV of the Berlín Deinstitutionalisation study [in Germán]. Psychiatr Prax 2000; 27: 183–8.Google Scholar
Hoffmann, K, Priebe, S.Needs for help and support in the view of schizophrenic long-term patients and of their therapists [in Germán]. Fortschritte Neurologie und Psychiatrie 1996; 64: 473–81.CrossRefGoogle Scholar
Horvath, O, Greenberg, LS.The working alliance: theory, research and practice. New York: Wiley; 1994.Google Scholar
Klinkenberg, WD, Calsyn, RJ, Morse, GA.The helping alliance in case management for homeless persons with severe mental illness. Community Ment Health J 1998; 34: 569–78.CrossRefGoogle ScholarPubMed
Krupnick, JL, Sotsky, SM, Simmens, S, Moyer, J, Elkin, I, Watkins, J, et al.The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: findings in the National programme. J Consult Clin Psychol 1996; 64: 532–9.CrossRefGoogle Scholar
Lehman, AE.Measures of quality of life among persons with severe and persistent mental disorders. Soc Psychiatry Psychiatr Epidemiol 1996; 31: 78–88.CrossRefGoogle ScholarPubMed
McCabe, R, Priebe, S.The therapeutic relationship in psychiatric settings: concepts and methods of assessment. Int J Soc Psychiatry 2003 (in press).Google Scholar
McCabe, R, Roder-Wanner, W, Hoffmann, K, Priebe, S.Therapeutic relationships and quality of life: association of two subjective constructs in schizophrenia parents. Int J Soc Psychiatry 1999; 45: 276–83.CrossRefGoogle Scholar
McGuire, R, McCabe, R, Priebe, S.Theoretical frameworks for understanding and investigating the therapeutic relationship in psychiatry. Social Psychiatry Psychiatr Epidemiol 2001; 36: 557–64.CrossRefGoogle Scholar
Neale, MS, Rosenheck, RA.Therapeutic alliance and outcome in a VA intensive case management programme. Psychiatr Serv 1995; 46: 719–21.Google Scholar
Overall, J, Gorham, DR.Thebriefpsychiatric rating scale. Psychol Rep 1962; 10: 799–812.CrossRefGoogle Scholar
Priebe, S, Roder-Wanner, UU, Kaiser, W.Quality of life in first-admitted schizophrenia patients: a follow-up study. Psychol Med 2000; 30: 225–30.CrossRefGoogle ScholarPubMed
Priebe, S, Broker, M.Prediction of hospitalisations by schizophrenia patients' assessment of treatment: an expanded study. J Psychiatr Res 1999; 33: 113–9.CrossRefGoogle ScholarPubMed
Priebe, S, Oliver, JP, Kaiser, W.Quality of life and mental health care. Petersfield, UK: Wrightson Biomedical Publishing; 1999.Google Scholar
Priebe, S, Kaiser, W, Huxley, P, Roder-Wanner, UU, Rudolf, H.Do different subjective evaluation criteria reflect distinct constructs? J Nerv Ment Dis 1998; 186: 385–92.CrossRefGoogle ScholarPubMed
Priebe, S, Gruyters, T.Patients' assessment of treatment predicting outcome. Schizophr Bull 1995; 21: 87–94.CrossRefGoogle ScholarPubMed
Priebe, S, Gruyters, T.Patients' and caregivers' initial assessments of day hospital treatment and course of symptoms. Compr Psychiatry 1994; 35: 234–8.CrossRefGoogle ScholarPubMed
Priebe, S, Grnyters, T.The role of the helping alliance in psychiatric community care: a prospective study. J Nerv Mental Dis 1993; 181: 552–7.CrossRefGoogle ScholarPubMed
Roder-Wanner, UU, Oliver, JPJ, Priebe, S.Does quality of life differ in schizophrenic women and men? An empirical study. Int J Soc Psychiatry 1997; 43: 129–41.CrossRefGoogle ScholarPubMed
Rudolf, H, Priebe, S.Subjective quality of life in female in-patients with depression: a longitudinal study. Int J Soc Psychiatry 1999; 45: 238–46.CrossRefGoogle ScholarPubMed
Solomon, P, Draine, J, Delaney, MA.The working alliance and consumer case management. J Ment Health Adm 1995; 22: 126–34.CrossRefGoogle ScholarPubMed
Tattan, T, Tarrier, N.The expressed emotion of case managers of the seriously mentally ill: the influence of expressed emotion on clinical outcomes. Psychol Med 2000; 30: 195–204.CrossRefGoogle ScholarPubMed
Von Zerssen, D.Clinical self-rating scales (CSr-S) of the Munich Psychiatric Information System (Psych IS, Munich). In: Sartorius, N, Ban, TA, editors. Assessment of depression. Berlin: Springer; 1986. p. 270–303.CrossRefGoogle Scholar