Psychotherapeutic work focused on structural personality functioning deficits : systematization of tools for clinical practice

Abstract

Background: Psychotherapists working in institutional contexts, especially in public health centers, must quickly resolve cases of multiple levels of severity due to the high demand for care and multiple obstacles that make long treatments unfeasible. Focal psychotherapy makes it possible to abbreviate treatments, but it is difficult to implement in patients with personality functioning difficulties. Objective: To propose an operational system of psychotherapeutic tools focused on structural personality functioning deficits, incorporating the perspectives of specialists and the analysis of video-recorded psychotherapy sessions. Methodology: Two qualitative studies were implemented: first, an open-coding analysis to determine and classify the therapeutic guidelines of the Manual of Structure-Oriented Psycho-therapy (Rudolf, 2013) and those obtained from interviews with specialists in the Operationalized Psychodynamic Diagnosis System (OPD-2); second, a study consisting in the observation of 45 psychotherapy sessions to identify and characterize the psychotherapeutic guidelines and interventions categorized earlier and create new interventions not considered in the first study. The results of both studies were integrated to develop an operational system of psychotherapeutic tools. Results: The operational system of psychotherapeutic tools developed comprises three levels and features the characterization of six Therapeutic Principles, 33 Therapeutic Guidelines, and 59 Therapeutic Interventions with their respective clinical examples. The system is characterized by the presence of common factors for an effective psychotherapy and elements that typify supportive therapies, complemented with specific components for dealing with structural deficits susceptible of modularization. Conclusions: The system is expected to allow practitioners to work focally with patients with a wide range of structural deficits of multiple levels of severity. The clinical tools proposed are flexible enough and include the necessary components to be well received by professionals from a wide range of clinical training backgrounds and be implemented as an initial approach within a tiered treatment system for personality problems.