Rupturas de la Alianza Terapéutica: un estudio de caso interrumpido en psicoterapia psicoanalítica con un paciente limítrofe

Autores/as

DOI:

https://doi.org/10.22235/cp.v14i2.2321

Palabras clave:

rupturas, alianza terapéutica, psicoterapia, investigación de procesos, Trastorno de Personalidad Limítrofe

Resumen

Este trabajo tiene como objetivo comprender los procesos de ruptura de la Alianza Terapéutica (AT) de un caso de psicoterapia psicoanalítica (PP) interrumpida realizada con un paciente con Trastorno de Personalidad Borderline (TPB). Se trata de un estudio de caso sistemático, el caso contempla 15 sesiones de PP, un paciente con quejas de impulsividad y dificultades de relación y su terapeuta. Las sesiones fueron grabadas en vídeo y transcritas. La identificación de las rupturas en la AT fue hecha por el Rupture Resolution Rating System. Se encontraron 100 rupturas de la AT, de estas 69% son rupturas de evitación y 31% de confrontación. Han sido verificadas 30 contribuciones del terapeuta para las rupturas. Las rupturas de evitación son más sutiles y de difícil identificación, presentándose en mayor frecuencia que las de confrontación en el tratamiento. Ante los pacientes con TPB los terapeutas deben desarrollar habilidades para hacer intervenciones con foco sobre la AT. Se destaca la necesidad de otros estudios que busquen replicar la investigación en otros casos de éxito y fracaso terapéutico.

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Arnow, B. A., Blasey, C., Manber, R., Constantino, M. J., Markowitz, J. C., Klein, D. N., … Rush, A. J. (2007). Dropouts versus completers among chronically depressed outpatients. Journal of Affective Disorders, 97(1–3), 197-202. doi: 10.1016/j.jad.2006.06.017

Bados, A., Balaguer, G., & Saldaña, C. (2007). The Efficacy of Cognitive–Behavioral Therapy and the Problem of Drop-Out. Journal of Clinical Psychology, 63(6), 585-592. doi: 10.1002/jclp

Bateman, A., Campbell, C., Luyten, P., & Fonagy, P. (2018). A mentalization-based approach to common factors in the treatment of borderline personality disorder. Current Opinion in Psychology, 21, 44-49. doi: 10.1016/j.copsyc.2017.09.005

Barros, P., Altimir, C., & Pérez, J. C. (2016). Patients’ facial-affective regulation during episodes of rupture of the therapeutic alliance/Regulación afectivo-facial de pacientes durante episodios de ruptura de la alianza terapéutica. Estudios de Psicología, 37(2-3), 580-603. doi: 10.1080/02109395.2016.1204781

Barcellos, M., Cardon, L., & Kieling, C. (2018). Evidências em Psicoterapia. Em A. . Cordioli & E. H. Grevet (Eds.), Psicoterapia. Abordagens Atuais (4th ed.). Porto Alegre: Artmed.

Barnow, S., Stopsack, M., Grabe, H. J., Meinke, C., Spitzer, C., Kronmüller, K., & Sieswerda, S. (2009). Interpersonal evaluation bias in borderline personality disorder. Behaviour Research and Therapy, 47(5), 359-365. doi: 10.1016/j.brat.2009.02.003

Benjamin, L. . (1993). Diagnosis and treatment of personality disorders: A structural approach. New York: G. Press, Ed.

Bennett, D., Parry, G., & Ryle, A. (2006). Resolving threats to the therapeutic alliance in cognitive analytic therapy of borderline personality disorder: A task analysis. Psychology and Psychotherapy: Theory, Research and Practice, 79(3), 395-418. doi: 10.1348/147608305X58355

Bernecker, S. L., Levy, K. N., & Ellison, W. D. (2014). A meta-analysis of the relation between patient adult attachment style and the working alliance. Psychotherapy Research, 24(1), 12-24. doi: 10.1080/10503307.2013.809561

Bordin, E.S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychoterapy: Theory, Research and Practice, 16(3), 252-260.

Boritz, T., Barnhart, R., Eubanks, C. F., & McMain, S. (2018). Alliance Rupture and Resolution in Dialectical Behavior Therapy for Borderline Personality Disorder. Journal of Personality Disorders, 32(Supplement), 115-128. doi: 10.1521/pedi.2018.32.supp.115

Bucci, W. (2007). Pesquisa sobre processo. Em E. Person, A. Cooper, & G. Gabbard (Eds.), Compêndio de Psicanálise (1st ed.), (pp. 320-336). Porto Alegre: Artmed.

Caligor, E., Kernberg, O. F., & Clarkin, J. (2008). Psicoterapia dinâmicas das patologias leves da personalidade. Porto Alegre: Artmed.

Cash, S. K., Hardy, G. E., Kellett, S., & Parry, G. (2014). Alliance ruptures and resolution during cognitive behaviour therapy with patients with borderline personality disorder. Psychotherapy Research, 24(2), 132-145. doi: 10.1080/10503307.2013.838652

Coady, N. (1991). Therapist Interpersonal Processes and Outcomes in Psychodynamic Psychotherapy. Reasearch on Social Work Practice, 1(2), 122-138.

Cordioli, A. V., & Grevet, E. H. (2018). Psicoterapias: Abordagens Atuais (4th ed.). Porto Alegre: Artmed.

Doran, J. M. (2016). The working alliance: Where have we been, where are we going? Psychotherapy Research, 26(2), 146-163. doi: 10.1080/10503307.2014.954153

Doran, J. M., Safran, J. D., & Muran, J. C. (2017). An Investigation of the Relationship Between the Alliance Negotiation Scale and Psychotherapy Process and Outcome. Journal of Clinical Psychology, 73(4), 449-465. doi: 10.1002/jclp.22340

Dotta, P. (2019). Rupturas da Aliança Terapêutica: ilustração de um sistema de avaliação e análise de um caso de abandono em psicoterapia. Dissertação de Mestrado, Universidade do Vale do Rio dos Sinos - UNISINOS, Programa de Pós-graduação em Psicologia Clínica, Rio Grande do Sul, São Leopoldo, Brasil.

Edwards, D. J. (2007). Collaborative Versus Adversarial Stances in Scientific Discourse: Implications for the Role of Systematic Case Studies in the Development of Evidence-Based Practice in Psychotherapy. Pragmatic Case Studies in Psychotherapy, 3(1), 6-34. doi: 10.14713/pcsp.v3i1.892

Eubanks, C. F., Muran, J. C., & Safran, J. D. (2014). Alliance-focused training. Psychotherapy Theory Research Practice Training, 52(2), 169-173. doi: 10.1037/a0037596

Eubanks, C. F., Muran, J. C., & Safran, J. D. (2015). Rupture Resolution Rating System (3RS): Manual. ResearchGate, (January), 1-16. doi: 10.13140/2.1.1666.8488

Eubanks, C. F., Lubitz, J., Muran, J. C., & Safran, J. D. (2018a). Rupture Resolution Rating System (3RS): Development and validation. Psychotherapy Research, (January), 1-16. doi: 10.13140/2.1.1666.8488

Eubanks, C. F., Sinai, M., Israel, B., Muran, J. C., & Safran, J. D. (2018b). Alliance Rupture Repair: A Meta-Analysis. Psychotherapy, 55(4), 508-519. doi: 10.1037/pst0000185.supp

Geremia, L., Benetti, S. P. C., Esswein, G. C., & Bittencourt, A. A. (2016). A aliança terapêutica no paciente diagnosticado com transtorno de personalidade borderline. Perspectivas Em Psicologia, 20(2). doi: 10.14393/PPv20n2a2016-03

Gersh, E., Hulbert, C. A., McKechnie, B., Ramadan, R., Worotniuk, T., & Chanen, A. M. (2017). Alliance rupture and repair processes and therapeutic change in youth with borderline personality disorder. Psychology and Psychotherapy: Theory, Research and Practice, 90(1), 84-104. doi: 10.1111/papt.12097

Gomes, F. G. (2015). Aliança terapêutica e a relação real com o terapeuta. Em S. EIZIRIK, Cláudio L; Aguiar, Rogério W; Schestatsky (Ed.), Psicoterapia de orientação analítica : fundamentos teóricos e clínicos (3 ed.) (pp. 238-248). Porto Alegre: Artmed.

Gülüm, İ. V, Soygüt, G., & Safran, J. D. (2018). A comparison of pre-dropout and temporary rupture sessions in psychotherapy. Psychotherapy Research, 28(5), 685-707. doi: 10.1080/10503307.2016.1246765

Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9-16. doi: 10.1037/a0022186

Jones, E. E. (2000). Therapeutic Action: A guide to psychoanalytic therapy. New Jersey: Aronson.

Kernberg, O. (2012). The Inseparable Nature of Love and Aggression: Clinical and Theoretical Perspectives. Washington: American Psychiatric Association Publishing.

Koons, C. K., Robins, C. J., Tweed, J. L., Lynch, T. R., Gonzalez, A. M., Mogs, J. Q., … Bastian, L. A. (2001). Efficacy of Dialectical Behavior Therapy in Women Veterans With Borderline Personality Disorder. Behavior Therapy, 32, 371-390. doi: 10.1016/S0005-7894(01)80009-5

Krause, M., Altimir, C., & Horvath, A. (2011). Deconstructing the therapeutic alliance: Reflections on the underlying dimensions of the concept. Clinical and Health, 22(3), 267-283. doi: 10.5093/cl2011v22n3a7

Kröger, C., Harbeck, S., Armbrust, M., & Kliem, S. (2013). Effectiveness, response, and dropout of dialectical behavior therapy for borderline personality disorder in an inpatient setting. Behaviour Research and Therapy, 51(8), 411-416. doi: 10.1016/j.brat.2013.04.008

Lazarus, S. A., Cheavens, J. S., Festa, F., & Zachary Rosenthal, M. (2014). Interpersonal functioning in borderline personality disorder: A systematic review of behavioral and laboratory-based assessments. Clinical Psychology Review, 34(3), 193-205. doi: 10.1016/j.cpr.2014.01.007

Leichsenring, F., Leibing, E., Kruse, J., New, A. S., & Leweke, F. (2011). Borderline personality disorder. The Lancet, 377, 453-461.

Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., ... & Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of general psychiatry, 63(7), 757-766. doi: 10.1001/archpsyc.63.7.757.

Luz, A. B. (2015). Fases da Psicoterapia. Em C. L. Eizirik, R. W. de Aguiar, & S. S. Schestatsky (Eds.), Psicoterapia de Orientação Analítica: fundamentos teóricos e clínicos (pp. 249-266). Porto Alegre: Artmed.

McMain, S. F., Links, P. S., Gnam, W. H., Guimond, T., Cardish, R. J., Korman, L., & Streiner, D. L. (2009). A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. American Journal of Psychiatry, 166(December), 1365-1374. doi: 10.1176/appi.ajp.2009.09010039

Muran, J. C., Safran, J., Gorman, B. S., Samstag, L. W., Eubanks C.F., & Winston, A. (2009). The relationship of early alliance ruptures and their resolution to process and outcome in three time-limited psychotherapies for personality disorders. Psychotherapy: Theory, Research, Practice, Training, 46(2), 233-248. doi: 10.1037/a0016085

Safran, J. D., Israel, B., & Einstein, A. (2006). Has the concept of the therapeutic alliance outlived its usefulness ?, 43(3), 286-291. doi: 10.1037/0033-3204.43.3.286

Safran, J. D., & Kraus, J. (2014). Alliance ruptures, impasses, and enactments: A relational perspective. Psychotherapy, 51(3), 381. doi: 10.1037/a0036815

Safran, J. D, & Muran, J. C. (1996). The resolution of ruptures in the therapeutic alliance. Journal of Consulting and Clinical Psychology, 64(3), 447-458. doi: 10.1037/0022-006X.64.3.447

Safran, J. D., & Muran, J. C. (2000). Resolving therapeutic alliance ruptures: Diversity and integration. Journal of Clinical Psychology, 56(2), 233-243. doi: 10.1002/(SICI)1097-4679(200002)56:2<233::AID-JCLP9>3.0.CO;2-3

Safran, J. D, & Muran, J. C. (2006). Has the concept of the therapeutic alliance outlived its usefulness? Psychotherapy: Theory, Research, Practice, Training, 43(3), 286-291. doi: 10.1037/0033-3204.43.3.286

Safran, J. D, Muran, J. C., & Eubanks, C.F. (2011). Repairing alliance ruptures. Psychotherapy, 48(1), 80-87. doi: 10.1037/a0022140

Safran, J. D., Muran, J. C., & Proskurov, B. (2009). Alliance, negotiation, and rupture resolution. In Levy, R. A. Ablo. J. S. Gabbard, G. O. Handbook of evidence-based psychodynamic psychotherapy (pp. 201-225). Humana Press.

Safran, J. D, Muran, J. C., & Samstag, L. W. (1994). Resolving therapeutic alliance ruptures: A task analytic investigation. The Working Alliance: Theory, Research, and Practice, (July 2015), 225-255.

Samstag L. W., Muran, J. C., Wachtel, P. L., Slade, A., Safran, J. D., & Winston M. D, A. (2008). Evaluating Negative Process: A Comparison of Working Alliance, Interpersonal Behavior, and Narrative Coherency Among Three Psychotherapy Outcome Conditions. American Journal of Psychotherapy, 62(2), 165-194.

Sharf, J., Primavera, L. H., & Diener, M. J. (2010). Dropout and therapeutic alliance: A meta-analysis of adult individual psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 47(4), 637-645. doi: 10.1037/a0021175

Serralta, F. B., Nunes, M. L. T., & Eizirik, C. L. (2007). Elaboração da versão em português do Psychotherapy Process Q-Set. Revista de Psiquiatria Do Rio Grande Do Sul, 29(1), 44-55. doi: 10.1590/S0101-81082007000100011

Serralta, F B, Nunes, M. L. T., & Eizirik, C. L. (2011). Considerações metodológicas sobre o estudo de caso na pesquisa em psicoterapia. Estudos de Psicologia (Campinas), 28(4), 501-510.

Shedler, J., & Westen, D. (1998). Refining the Measurement of Axis II: A Q-Sort Procedure for Assessing Personality Pathology. Assessment, 5(4), 333–353. https://doi.org/10.1177/107319119800500403

Skodol, A. E., Gunderson, J. G., Pfohl, B., Widiger, T. A., Livesley, W. J., & Siever, L. J. (2002). The borderline diagnosis I: psychopathology, comorbidity, and personaltity structure. Biological Psychiatry, 51(12), 936-950. doi: 10.1016/S0006-3223(02)01324-0

Spinhoven, P., Giesen-Bloo, J., van Dyck, R., Kooiman, K., & Arntz, A. (2007). The therapeutic alliance in schema-focused therapy and transference-focused psychotherapy for borderline personality disorder. Journal of Consulting and Clinical Psychology, 75(1), 104-115. doi: 10.1037/0022-006X.75.1.104

Weinberg, I., Ronningstam, E., Goldblatt, M. J., Schechter, M., & Maltsberger, J. T. (2011). Common factors in empirically supported treatments of borderline personality disorder. Current psychiatry reports, 13(1), 60-68. doi: 10.1007/s11920-010-0167-x

Westen, D., & Shedler, J. (1999). Revising and Assessing Axis II, Part I: Developing a Clinically and Empirically Valid Assessment Method. American Journal of Psychiatry, (2), 258-272. doi: 10.1016/j.desal.2014.06.029

Zilcha-Mano, S., Muran, J. C., Eubanks, C. F., Safran, J. D., & Winston, A. (2018). When therapist estimations of the process of treatment can predict patients rating on outcome: The case of the working alliance. Journal of Consulting and Clinical Psychology, 86(4), 398-402. doi: 10.1037/ccp0000293

Publicado

2020-10-13

Cómo citar

Dotta , P. ., Feijó , L. P. ., & Barcellos Serralta , F. . (2020). Rupturas de la Alianza Terapéutica: un estudio de caso interrumpido en psicoterapia psicoanalítica con un paciente limítrofe. Ciencias Psicológicas, 14(2), e-2321. https://doi.org/10.22235/cp.v14i2.2321

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