Made available in DSpace on 2016-04-28T20:38:50Z (GMT). No. of bitstreams: 1 Caroline Wajss Zylberkan.pdf: 2254771 bytes, checksum: a14c7ebac62788f157bfaaf15dba62f4 (MD5) Previous issue date: 2014-02-21 / The main objective of this project was to understand the implications of family therapy in the treatment of a patient cared for in the program for eating disorders of the Hospital das Clínicas, at the Instituto de Psiquiatria de São Paulo (IPq HC-FMUSP). This objective was drafted from the possibility of creating a space for dialogue among those participating in this research project, by way of semi-structured interviews which could increase the understanding and the reach of family therapy in this context. An effort was made specifically to extend knowledge of treatment of eating disorders beyond family therapy, with a view to perceive and analyze the context of the relationships and life both within the family organization of the patient being treated, as well as within the professional system involved in the treatment. For this end, interviews were held with three of the professionals who were part of the multidisciplinary team which took care of the chosen case during the last five years, being one a psychiatrist, one a nutritionist and one an individual psychologist, apart from the patient herself and members of her family. For data analysis information was gleaned from the interviews of each participant, according to the importance of their content and the objective of this research project. Thus some themes were identified which could didactically outline some specific points relevant to the discussion. Taking into consideration the collaborative approach proposed by Harlene Anderson (2011), we understand the different voices offered by our participants as possible interpretations capable of communicating amongst themselves. From this material it was possible to identify some of the expectations of the multidisciplinary team in relation to the effects of family therapy in the treatment of eating disorders in a hospital setting, and also the relevance of this care both to the patient as well as her family. It became evident that family therapy was valued by all those involved in the research project as a necessary support for the patient and her family, insofar that from the specific point of view of each one it contributed to greater adhesion to the treatment. However this valuing implies in fitting the family therapy into a format of behavior which is aimed at the symptom, and this research project endeavored to reflect on the use of this space for the inter-relational process in which the symptom arises, and on the possible reach of this care for a long term process which would look at the dynamics of the relationships and also beyond the symptom / O objetivo principal deste trabalho foi compreender os significados da terapia familiar no tratamento de uma paciente atendida no programa para transtorno alimentar do Hospital das Clínicas, no Instituto de Psiquiatria de São Paulo (IPq HC-FMUSP). Esse objetivo foi delineado a partir da possibilidade de criar um espaço de diálogo entre os participantes desta pesquisa, por meio de entrevistas semiestruturadas que pudessem ampliar o entendimento e o alcance da terapia familiar nesse contexto. De maneira específica, buscou-se estender o conhecimento sobre o tratamento dos transtornos alimentares para além da terapia familiar, com vistas a perceber e analisar os contextos das relações e da vivência tanto na organização familiar da paciente em tratamento, quanto na organização do sistema profissional envolvido no tratamento. Para isso, foram entrevistados três profissionais que participaram da equipe multidisciplinar que tratou do caso escolhido durante os últimos cinco anos, sendo um psiquiatra, uma nutricionista e um psicólogo individual, além da própria paciente e de seus familiares. Para a análise dos dados foram feitos recortes das entrevistas de cada participante, a partir da importância do conteúdo relatado e do objetivo desta pesquisa. Assim, levantaram-se alguns temas que pudessem delinear de forma didática alguns pontos específicos e relevantes para discussão. Levando em consideração a abordagem colaborativa proposta por Harlene Anderson (2011), compreendemos as diferentes vozes oferecidas por nossos participantes como possibilidades de entendimentos capazes de dialogar entre si. Diante desse material, foi possível verificar algumas expectativas da equipe multidisciplinar em relação à atuação da terapia familiar no tratamento dos transtornos alimentares no contexto hospitalar, bem como a relevância desse atendimento tanto para a paciente quanto para os seus familiares. Ficou evidente que a terapia familiar foi valorizada por todos os envolvidos na pesquisa como um suporte necessário à paciente e seus familiares, na medida em que, do ponto de vista específico de cada um contribuiu para maior adesão ao tratamento. No entanto, essa valorização implica em colocar a terapia familiar dentro de um formato de conduta voltada para o sintoma, e esta pesquisa buscou refletir sobre a utilização desse espaço para a compreensão do processo inter relacional no qual se produz o sintoma e nas possibilidades de alcance desse atendimento para um trabalho a longo prazo que olhe para as dinâmicas da relação e para além do sintoma

Este trabalho objetivou conhecer o processo de busca e a clientela atendida em terapia de casal e família. Para tanto, realizaram-se dois estudos. Inicialmente, através de uma revisão sistemática da literatura, foram identificados seis fatores associados à busca pelas terapias de casal e família: fatores pessoais, relacionais, culturais, de gênero, estratégias anteriores de ajuda e tipo de problema. Posteriormente, através de um estudo empírico, a clientela atendida em terapia familiar em uma clínica-escola de Porto Alegre (RS) foi caracterizada. Foram realizadas entrevistas estruturadas com 41 adultos encaminhados para terapia familiar, nas quais foram investigadas variáveis sociodemográficas e familiares, o processo de busca de ajuda, o problema apresentado, tentativas anteriores de ajuda utilizadas e expectativas sobre o tratamento. Os resultados permitem reflexões sobre a prática clínica com famílias em clínicas-escola, especialmente a respeito do envolvimento dos clientes no processo terapêutico e à transição da queixa para a demanda desde o período de avaliação inicial. / This research aimed to investigate the help seeking process and the clients attended in couples and family therapy. To achieve this objective, two studies were realized. First, a systematic literature review identified six factors associated with the search for couples and family therapy: personal factors, relationship factors, gender, cultural aspects, prior sources of help and type of problem. After that, a second study characterized the clients attended in family therapy in a school clinic located in Porto Alegre (RS). Structured interviews with 41 adults referred for family therapy were realized. Sociodemographic and familial variables, the search for help process, the main problem, the prior sources of help and the expectations about the treatment were investigated. These results allows reflections about family therapy practice in school clinics, especially about the involvement of the clients on therapeutic process and the transition from the first complaint to the real demand since evaluation period.

Adolescentes do sexo feminino são a população mais frequentemente acometida pela anorexia nervosa (AN), com prevalência média de 2,5%, quando considerados critérios diagnósticos adaptados para esta faixa etária. A apresentação da AN em adolescentes é semelhante a de adultos, no entanto existem particularidades nos sintomas relacionadas ao nível de desenvolvimento cognitivo e emocional. A AN manifesta-se por: perda de peso, perturbações na forma de vivenciar a forma corporal, medo de engordar, restrição alimentar, comportamentos compensatórios e alterações menstruais. No Brasil, existem poucos recursos especializados para o tratamento da AN na adolescência e não foram realizados previamente estudos sistematizados sobre o tema. Estudos realizados em países de língua inglesa demonstram que o tratamento familiar (TF) apresenta bons resultados no tratamento da AN em adolescentes. Este estudo tem como objetivo a comparação de efetividade e de custos entre o TF e o tratamento multidisciplinar (TM). Inicialmente foi realizado um estudo piloto, incluindo nove pacientes de 11 a 17 anos do sexo feminino com diagnóstico de AN, tratadas com o TF. Posteriormente foi realizado um estudo comparativo, com os mesmos critérios de inclusão, com 20 pacientes que receberam o TF e foram comparadas com um grupo-controle histórico de 24 pacientes tratadas com TM. Foram calculados os custos diretos de ambas as modalidades de tratamento. Foram utilizadas como medidas de avaliação: DAWBA, CGAS, EDE-Q. No estudo piloto, as variáveis peso, IMC, EDE-Q, CGAS e amenorreia foram comparadas antes e após o TF. Foram observados resultados estatisticamente significativos em recuperação de peso e IMC (p=0,036). Foi observada melhora das demais variáveis após o tratamento, no entanto estes resultados não foram estatisticamente significativos. No estudo comparativo, 75% das pacientes que receberam o TF e 62,5% das pacientes que receberam TM apresentaram recuperação dos sintomas de AN, sem diferença estatisticamente significativa entre os grupos (p=0,378). Ambos os grupos apresentaram recuperação de peso, IMC e CGAS satisfatórias após o tratamento, sem diferença estatisticamente significativa entre os grupos. Tanto no TF quanto no TM, o maior tempo de sintomas antes do início do tratamento interferiu negativamente na resposta ao tratamento, reduzindo a chance de recuperação dos sintomas. Os custos diretos do TM são aproximadamente o dobro dos custos do TF. Tanto o TF quanto o TM demonstraram-se alternativas efetivas de tratamento para AN ! na população estudada. No entanto, o custo do TM é consideravelmente maior. O TF é uma alternativa de tratamento efetiva e economicamente viável, podendo ser disseminado para outros centros, possibilitando maior acesso a tratamento para adolescentes com AN / Female adolescents are the population most frequently affected by anorexia nervosa (AN), with average prevalence of 2.5% when adapted diagnostic criteria for this age group are considered. AN presentation in adolescents is similar to that of adults, but there are peculiarities in symptoms related to the level of cognitive and emotional development. AN main symptoms are: weight loss, disturbance in the way body shape is experienced, fear of becoming fat, dietary restriction, compensatory behaviors and menstrual abnormalities. In Brazil, there are few specialized resources for AN treatment in adolescence and no previous systematic studies have been conducted on this theme. In English-speaking countries, some studies have shown that the family-based treatment (FBT) is effective for adolescent AN. The aim of this study is to compare the effectiveness and the costs between the FBT and the multidisciplinary treatment (MT). Initially, a pilot study was conducted, including nine female patients from 11 to 17 years old diagnosed with AN, and treated with FBT. It was later performed a comparative study with the same inclusion criteria. Twenty patients who received FBT were compared with a historical control group of 24 patients treated with MT. We calculated the direct costs of both treatment modalities. The evaluation measures were: DAWBA, CGAS, EDE-Q. In the pilot study, the variables weight, BMI, EDE-Q, CGAS and amenorrhea were compared before and after FBT. We observed statistically significant results in weight and BMI recovery (p=0.036). The other variables have improved after treatment, although results were not statistically significant. In the comparative study, 75% of patients receiving FBT and 62.5% of patients receiving MT recovered from AN symptoms, no statistically significant difference was found between groups (p=0.378). Both groups have shown satisfactory recovery of weight, BMI and CGAS after treatment, with no statistical significant difference between groups. Both in the FBT and in the MT, the greater duration of symptoms before starting treatment had negative influence on treatment response, reducing the chance of recovery. The direct costs of the MT are approximately twice the cost of the FBT. Both the FBT and the MT were shown to be effective for AN treatment in the study population. However, the costs of MT are considerably higher. The FBT is an effective and economically viable treatment alternative and, can be disseminated to other centers, allowing ! greater treatment access for adolescents with AN

The current study investigated how three distinct types of childhood abuse—witnessing of parental domestic violence, experiencing physical abuse and total in-home violence, and experiencing sexual abuse—predicted partner reports of relational violence through the mediating factors self-perceptions of attachment and partner reports of relational aggression. The study used paired dyadic data from 1,658 couples who had completed the RELATionship Evaluation (RELATE). The Family Violence, the Brief Accessibility and Responsiveness, Couples Relational Aggression and Victimization, and the Conflict Tactics scales were the measures used. Data was analyzed by using structural equation modeling to estimate an actor-partner interdependence model exploring these relationships. Results showed only female childhood sexual abuse had direct associations with male relational violence; however, several mediating paths were identified.

The purpose of this study was to investigate the relationship between relational aggression and sexual satisfaction, as well as the mediating role of attachment on this relationship. Data came from the Relationship Evaluation Survey (RELATE) comprised of the matched-pair responses of 797 couples in serious dating, engaged, or married relationships. Results showed the greater the perceived relational aggression the lower the sexual satisfaction for both self and partner, regardless of gender. Additionally, it appears a more satisfying sexual relationship can occur when an individual experiences a secure attachment base and can feel confident that his/her relationship is safe. For both genders, the more relationally aggressive behaviors reported, the lower the reports of secure attachment behaviors. Implications for clinicians and future research are discussed.

This pilot study examined the effectiveness of Emotionally Focused Couples Therapy (EFT) compared to Treatment As Usual (TAU) in improving cortisol functioning among distressed couples. It also investigated the role of gender in cortisol functioning. Measures for cortisol were collected at five time points, both at pre- and posttreatment. Data were collected from a total of 60 couples, 20 of which received EFT and 40 of which received TAU. Overall, results from a two-way analysis of variance suggest that there are no significant differences between men or women, nor among couples in EFT and TAU, in posttreatment cortisol functioning. Directions for future research are discussed.

Couple therapy is successful in treating relationship distress. However, couple therapy does not benefit everyone. Consequently, it is important to study factors that predict therapeutic success. One such factor is what predicts the development of the therapeutic alliance in couple therapy. The purpose of this study was to code therapist behaviors, therapist warmth, empathy, presence, validation, collaboration, and technique factors (systemically-based techniques and session structure), in the first session of couple therapy to examine their ability to predict two aspects of the therapeutic alliance, between- and within-alliance, after the session for males and females. The hypotheses were tested utilizing multiple one-way ANOVAs. Results indicated that none of the therapist variables predicted either of the outcome alliance variables for males or females. More research needs to be done to find what therapist behaviors predict the therapeutic alliance.

Ch. 1. Introduction and overview -- Ch. 2. The genograms of family therapy -- Ch. 3. The family practitioner as person and professional -- Ch. 4. Virtue, ethics, and legality in family practice -- Ch. 5. Theories and techniques of family therapy and counseling -- Ch. 6. Adlerian family therapy -- Ch. 7. Multigenerational family therapy -- Ch. 8. Human validation process model -- Ch. 9. Symbolic-experiential family therapy -- Ch. 10. Structural family therapy -- Ch. 11. Strategic family therapy -- Ch. 12. Solution-focused and solution-oriented therapy -- Ch. 13. Postmodernism, social construction, and narratives in family therapy -- Ch. 14. Feminist family therapy -- Ch. 15. Cognitive-behavioral family therapy -- Ch. 16. Parenting for the 21st century -- Ch. 17. Integration I: from self-discovery to family practice: forming a relationship and family assessment -- Ch. 18. Integration II: shared meaning, facilitating change, and tailoring interventions. Theory and practice of family counseling and therapy, 2nd Edition embraces multiple perspectives and provides a comprehensive discussion of contemporary family theories and practices, including human validation process and symbolic-experiential models. Bitter encourages students' personal growth and development as family therapists with a warm, inviting writing style and numerous self-reflection and active-learning exercises. Learning is enhanced through a consistent chapter organization and the use of a single case, the Quest family, throughout. This approach enables students to compare and contrast the various models and see how different approaches can be used in an integrated way. The text presents a four-stage process for conducting family sessions, including processes for forming relationships, family assessment, hypothesizing and shared meaning, and facilitating change. Each chapter ends with a Quest family case (which applies the model discussed in the chapter to the fictional Quest family), a summary and multicultural evaluation section, exercises for personal and professional growth, contact and Web information for finding out more about the specific therapy, recommended supplementary readings, and references. Additional cases throughout the text, based on Bitter's years of practice in marriage and family counseling, help students see how theories play out in the real world. A unique chapter on "Parenting for the 21st Century" addresses the fact that a majority of family counseling deals with parenting questions and issues. / https://dc.etsu.edu/etsu_books/1071/thumbnail.jpg

From the viewpoint of Self-Determination Theory, this study evaluated theoretically competing models examining the relationships among one’s fear of missing out (FOMO) and multiple indicators of relatedness (satisfaction and frustration) with well-being (life satisfaction) and ill-being (depression) among a sample of emerging adults. The first model conceptualized that higher levels of FOMO would be related to higher levels of depressive symptomology and lower levels of life satisfaction, and that relationship would be mediated by relatedness satisfaction and frustration. Alternatively, the second model conceptualized that relatedness satisfaction would serve as a moderator of the relationship between FOMO and depressive symptomology and life satisfaction. Model 1 results indicated that an individual’s FOMO was associated with lower relatedness satisfaction and higher relatedness frustration, and, in turn, both forms of relatedness were significantly associated with perceptions of life satisfaction and depression. Model 2 results also indicated that one’s relatedness satisfaction or frustration did not serve as a moderator between the relationship of FOMO and well-being or ill-being. Discussion of the importance of relationship attachments, as well as clinical implications, will be included.

Our presentation was aimed at providing a thorough overview of concepts that interfere with an adolescent’s ability to stay in school and graduate. Additionally, the presentation addressed what other factors of poverty, such as risk-taking behaviors (e.g., marijuana use, binge drinking, or sexual activity), might carry over into college life and affect a student’s academic career. Variables connected to family community, family responsibilities, and adolescents’ self-esteem were described as well. Finally, the presentation discussed factors that play into a student’s willingness to seek out college campus resources for support. With this paper, we hope to outline variables that lead to academic drawbacks within our youth and to raise awareness about the multi-faceted phenomenon of retention of students.