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Expectativas de resultado pré-tratamento e abandono precoce (dropout) em psicoterapia
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Abstract(s)
Um dos fatores comuns que pode contribuir para a compreensão do processo de mudança em psicoterapia são as expectativas dos clientes. De facto, as expectativas dos clientes em psicoterapia são preditores da eficácia da psicoterapia e podem justificar a variância encontrada nos resultados (Wampold, 2001). Embora tenham um valor modesto nos resultados da psicoterapia são fundamentais por refletirem uma série de características específicas do cliente, importantes para o planeamento da intervenção (Constantino, Arnkoff, Glass, Ametrano, & Smith, 2011). Além disso, também funcionam como variáveis mediadoras e moderadoras de mecanismos em todo o processo psicoterapêutico e podem contribuir ainda na decisão do cliente para permanecer ou abandonar precocemente a psicoterapia (dropout) (Swift, & Greenberg, (2012).
O dropout tem expressão significativa (1 em 5 clientes abandonam precocemente a psicoterapia), o que tem/pode ter consequências diretas para todos os intervenientes (cliente, psicoterapeuta, sistemas de prestação de cuidados) e continua a ser uma dimensão ainda pouco compreendida em psicoterapia. A literatura indica diversos fatores que influenciam a decisão de abandonar a terapia, no entanto, relativamente à associação entre as expectativas e o dropout os estudos ainda são inconsistentes (Santagelo, 2020).
Tendo como ponto de partida a necessidade de se aprofundar o conhecimento sobre o papel que as expectativas dos clientes podem ter na psicoterapia, realizámos um estudo descritivo, de natureza observacional, em que as variáveis estudadas foram as expectativas de resultado pré-tratamento e a situação em termos de acompanhamento (continuidade vs. dropout) e cujos objetivos foram: (i) descrever as expectativas de resultado pré-tratamento; e (ii) analisar a relação entre estas expectativas e o abandono precoce (dropout) da psicoterapia em clientes adultos.
A amostra ficou constituída por 57 participantes, 63.2% do sexo feminino e 36.8% do sexo masculino, com idades compreendidas entre os 18 e os 79 anos (M=44.7; DP=17.4), atendidos numa clínica pedagógica de psicologia de uma Universidade do Norte de Portugal. As expectativas mais relatadas pelos participantes foram as denominadas como “horizontais” (41.3%), as quais se referem à procura de uma solução imediata para os problemas/dificuldades (e.g., diminuir a ansiedade e o stress, desabafar, melhorar os relacionamentos e resolver problemas atuais), seguidas das expectativas “verticais” (38.4%), que se referem a movimentos para baixo (no “aqui e agora”) de mistura do antes e do depois (e.g., controlo emocional, conhecer-se melhor, ter mais confiança) e, por último, as expectativas de nível “transcendental” (20.3%) marcadas pelo movimento “aqui” e “lá”/”presente” e “ideal” (e.g., sentir-se melhor, ser feliz, bem estar familiar).
Quando comparados os grupos considerados, verificamos que os participantes que fizeram dropout apresentam, sobretudo, expectativas “verticais” enquanto os clientes que se mantiveram em acompanhamento apresentam expectativas “horizontais”. No entanto, estas diferenças não se mostraram estatisticamente significativas (X2=2.624; p=.269), o que nos permite concluir que as expectativas de resultado pré-tratamento e a situação em termos de acompanhamento são variáveis independentes.
In psychotherapy, client expectations are one of the common factors that may contribute to the knowledge of the change process. As a matter of fact, client expectations in psychotherapy are predictors of the effectiveness of psychotherapy and may account for the variance found in outcomes (Wampold, 2001). Although they have a modest value in psychotherapy outcomes, they are crucial as they reflect a number of specific client characteristics that are relevant for intervention planning (Constantino, Glass, Arnkoff, Ametrano, & Smith, 2011). In the same way, they also function as mediating and moderating variables of mechanisms throughout the psychotherapeutic process and may also contribute to the client's decision to remain in or abandon psychotherapy early (dropout) (Swift, & Greenberg, 2012). Dropout is common (1 in 5 clients leave psychotherapy early), which has/ may have direct consequences for all the participants (client, psychotherapist, care delivery systems) and remains a dimension still poorly understood in psychotherapy. The literature states several factors that influence the decision to abandon therapy, nevertheless, the association between expectations and dropout the studies are still insconsistent (Santagelo, 2020). With the necessity to improve the knowledge about the role that clients' expectations may play in psychotherapy as a starting point, we conducted a descriptive study, observational in nature, in which the variables studied were the pre-treatment outcome expectations and the situation in terms of follow-up (continuity vs. dropout) and whose objectives were: to describe the pre-treatment outcome expectations; and (ii) to analyse the relationship between these expectations and dropout from psychotherapy, in adult clients. The sample consisted by a total of 57 participants, 63.2% female and 36.8% male, aged between 18 and 79 years (M=44.7; SD=17.4), who were seen at a pedagogical psychology clinic, in adults' consultation. The most prevalent expectations reported by participants were the so-called "horizontal" (41.3%), which refer to the need to find an immediate solution to problems/difficulties (e.g., to reduce anxiety and stress, to release from stress, to improve relationships and to solve current problems), followed by the "vertical" expectations (38.4%), which refer decline perspective (in "here and now"), of blending before and after (e.g., emotional control, to know themselves better, to have more confidence), and at last the "transcendental" expectations (20.3%) characterised by "here" and "there/"present" and "ideal" expectations (e.g. to feel better, to be happy, family wellbeing). Comparing the groups, we found that participants who dropped out had mainly "vertical" expectations while clients who remained in follow-up had "horizontal" expectations. These differences, however, were not found to be statistically significant (X2=2.624; p=.269), which allows us to conclude expectations may not be relevant for clients to remain or drop out of psychotherapy. However, they may be both moderators and mediators of dropout in psychotherapy.
In psychotherapy, client expectations are one of the common factors that may contribute to the knowledge of the change process. As a matter of fact, client expectations in psychotherapy are predictors of the effectiveness of psychotherapy and may account for the variance found in outcomes (Wampold, 2001). Although they have a modest value in psychotherapy outcomes, they are crucial as they reflect a number of specific client characteristics that are relevant for intervention planning (Constantino, Glass, Arnkoff, Ametrano, & Smith, 2011). In the same way, they also function as mediating and moderating variables of mechanisms throughout the psychotherapeutic process and may also contribute to the client's decision to remain in or abandon psychotherapy early (dropout) (Swift, & Greenberg, 2012). Dropout is common (1 in 5 clients leave psychotherapy early), which has/ may have direct consequences for all the participants (client, psychotherapist, care delivery systems) and remains a dimension still poorly understood in psychotherapy. The literature states several factors that influence the decision to abandon therapy, nevertheless, the association between expectations and dropout the studies are still insconsistent (Santagelo, 2020). With the necessity to improve the knowledge about the role that clients' expectations may play in psychotherapy as a starting point, we conducted a descriptive study, observational in nature, in which the variables studied were the pre-treatment outcome expectations and the situation in terms of follow-up (continuity vs. dropout) and whose objectives were: to describe the pre-treatment outcome expectations; and (ii) to analyse the relationship between these expectations and dropout from psychotherapy, in adult clients. The sample consisted by a total of 57 participants, 63.2% female and 36.8% male, aged between 18 and 79 years (M=44.7; SD=17.4), who were seen at a pedagogical psychology clinic, in adults' consultation. The most prevalent expectations reported by participants were the so-called "horizontal" (41.3%), which refer to the need to find an immediate solution to problems/difficulties (e.g., to reduce anxiety and stress, to release from stress, to improve relationships and to solve current problems), followed by the "vertical" expectations (38.4%), which refer decline perspective (in "here and now"), of blending before and after (e.g., emotional control, to know themselves better, to have more confidence), and at last the "transcendental" expectations (20.3%) characterised by "here" and "there/"present" and "ideal" expectations (e.g. to feel better, to be happy, family wellbeing). Comparing the groups, we found that participants who dropped out had mainly "vertical" expectations while clients who remained in follow-up had "horizontal" expectations. These differences, however, were not found to be statistically significant (X2=2.624; p=.269), which allows us to conclude expectations may not be relevant for clients to remain or drop out of psychotherapy. However, they may be both moderators and mediators of dropout in psychotherapy.
Description
Keywords
Psicoterapia Expectativas de resultado pré-tratamento Dropout Psychotherapy Pre-treatment outcome expectations