Abstract: There is a diverse body of research that utilizes notions of the dynamical systems (DS) perspective to describe change processes in psychotherapy, understanding it as a non-linear self-organized system that presents emergent processes and structural variations. A systematic review of research in individual psychotherapy with adult patients addressed from this perspective has been carried out. The review was carried out supported by the PRISMA methodology tracking the main concepts of the DS perspective applied to individual psychotherapy of adults (between 1997 and 2019), in English and Spanish, using the electronic databases PsycINFO and ProQuest. The final selection included 34 studies, both case studies and naturalistic studies, covering different process and outcome variables of psychotherapy. The results highlight how such concepts help to understand patients' change as a nonlinear process, emphasizing its self-organizing characteristics, transitions from states that generate psychological distress to healthier states, and the formation of emergent patterns at different stages of psychotherapy. Some related aspects (e.g. role of the alliance, and of clinical interventions) that can be considered in the therapeutic work are discussed.

Resumen: Existe un variado número de investigaciones que emplea nociones de la perspectiva de sistemas dinámicos (SD) para describir procesos de cambio en psicoterapia, conceptualizándolo como un sistema no lineal autoorganizado que presenta procesos emergentes y variaciones estructurales. Se realizó una revisión sistemática de la investigación en psicoterapia individual con pacientes adultos abordada desde esta perspectiva. La revisión se sustentó en la metodología PRISMA rastreando los principales conceptos de la perspectiva SD aplicados a la psicoterapia individual de adultos (entre 1997 y 2019), en los idiomas inglés y español, utilizando las bases de datos electrónicas PsycINFO y ProQuest. La selección final incluyó 34 estudios, tanto estudios de caso como estudios naturalistas, que abordaron diferentes variables de proceso y resultado de la psicoterapia. Los resultados resaltan la forma en que dichos conceptos ayudan a comprender el cambio de los pacientes como un proceso no lineal, destacando sus características de autoorganización, transiciones desde estados que generan sufrimiento psicológico a estados más saludables, y la formación de patrones emergentes en diferentes etapas de la psicoterapia. Se discuten algunos aspectos derivados (p.e. rol de la alianza, y de las intervenciones clínicas) que pueden ser abordados en el trabajo terapéutico.

Abstract Background Studies indicate that the internalization of beliefs, prejudices and attitudes existing in society about sexual minorities strongly affect their mental health and could constitute a barrier to access to psychological and therapeutic support in LGB people. Objective To determine the association between levels of internalized sexual stigma (ISS) in self-identified lesbian, gay and bisexual (LGB) people with the presence of subjective distress, depressive and anxious symptoms, suicidality, and psychotherapy attendance. Methods An online questionnaire including questions on having attended or attending psychotherapy, as well as scales assessing internalized sexual stigma, subjective distress-subjective well-being, depression, and suicidality was completed by 669 cisgender self-identified lesbian, gay, and bisexual individuals. Results The results show a positive association between the level of ISS in LGB people with their levels of subjective distress, depressive and anxious symptomatology, and suicidality, and a negative association with being attending or having attended psychotherapy. Conclusions The implications of the results presented for the development of culturally competent psychotherapeutic interventions for patients belonging to sexual and gender diversity are discussed.

Resumen Antecedentes Estudios señalan que la internalización de creencias, prejuicios y actitudes existentes en la sociedad sobre las personas de la diversidad sexual afectan fuertemente su salud mental y podrían constituirse en una barrera de acceso a la ayuda psicológica y terapéutica en personas LGB. Objetivo Determinar la asociación entre los niveles de internalización de estigma sexual (ESI) en personas autoidentificadas como lesbianas, gay y bisexuales (LGB) con la presencia de malestar subjetivo, sintomatología depresiva y ansiosa, suicidalidad, y asistencia a psicoterapia. Método Un cuestionario aplicado de manera online que incluía preguntas sobre haber asistido o estar asistiendo a psicoterapia, además de escalas que evaluaban estigma sexual internalizado, malestar-bienestar subjetivo, depresión y suicidalidad fue respondido por 669 personas cisgenero autoidentificadas como lesbianas, gay y bisexuales. Resultados Los resultados muestran una asociación positiva entre el nivel de ESI en personas LGB con sus niveles de malestar subjetivo, sintomatología depresiva y ansiosa, y suicidalidad, y una asociación negativa con estar asistiendo o haber asistido a psicoterapia. Conclusiones Se discuten las implicancias de los resultados presentados para el desarrollo de intervenciones psicoterapéuticas culturalmente competentes para pacientes pertenecientes a la diversidad sexual y de género.

Resumen El presente estudio reporta los resultados de la implementación de un dispositivo audiovisual (TIC) y material de apoyo en cursos de Psicología, Sociología y Comunicación Social en dos universidades chilenas. Se produjo un microdocumental sobre programas sociales y sus resultados, y se elaboró material de apoyo consistente en cápsulas didácticas para cursos de intervención social y de investigación que contienen una sección del microdocumental y metodologías activas de aprendizaje. Se hizo una evaluación de procesos y de resultados, con metodología mixta, en la que participaron 87 estudiantes. Se presentan consideraciones sobre la implementación del dispositivo audiovisual y las metodologías activas, y se identifican como principales efectos la consolidación de los contenidos teóricos, el desarrollo de la reflexión profesional y una movilización de habilidades transversales. Se discute sobre aspectos clave en el uso de estas metodologías para potenciar la participación del alumnado y la formación integral.

Abstract This study reports the results of the implementation of an audiovisual (ICT) device and supporting material in psychology, sociology, and social communication courses in two Chilean universities. A micro-documentary about social programs and their outcomes was produced, and educational capsules containing a section of the microdocumentary together with active learning methodologies were prepared as supporting material. A process and outcome evaluation was conducted, with a mixed-methods methodology and in which a total of 87 students participated. We offer considerations on the implementation of the audiovisual device and active methodologies, and identify the main impacts as a consolidation of theoretical content, a development of professional reflection, and the deployment of interdisciplinary skills. Key aspects involved in using these methodologies to promote student engagement and comprehensive education are discussed.

Objective: To identify clinical and sociodemographic factors that increase or decrease suicidal risk in a clinical sample of subjects seeking mental health care. Method: A cross-sectional study was performed at three health centers in Santiago, Chile. The Parental Bonding Instrument (PBI), Depressive Experience Questionnaire (DEQ), Outcome Questionnaire (OQ-45.2), Reasons for Living Inventory (RFL), and State Trait Anger Expression Inventory (STAXI-2), in addition to a sociodemographic survey, were applied to 544 participants (333 with suicidal behavior and 211 without current suicidal behavior). Through hierarchical clustering analysis, participants were grouped by similarity regarding suicidal risk. Then, a regression analysis was performed using the Least Absolute Shrinkage and Selection Operator (LASSO) technique, and factors that decrease or increase suicide risk (SR) were identified for each cluster. Results: The resultant clusters were grouped mainly by the age of participants. The most important protective factor was having confidence in one’s own coping skills in difficult situations. Relevant risk factors were major depressive disorder (MDD), poor anger management, and difficulties in interpersonal relationships. Conclusions: Suicidal risk manifests differently throughout the life cycle, and different types of bonds may protect from or increase risk of suicide.

ABSTRACT: The aim of the study was to validate the Reasons for Living (RFL) Inventory in Chile, using a purposive and consecutive sample of 705 mental health patients in the Metropolitan Region. The RFL scale assesses the importance ascribed to reasons for living when contemplating suicide. The factorial structure of the scale was analyzed through exploratory and confirmatory analysis of the original instrument. Internal consistency, construct validity, and concurrent validity were studied and score parameters were defined. The suggested cut-off point for Chile is 4.1, which means that lower scores indicate a higher probability of suicide risk. Sensitivity was estimated at 62.1% and specificity at 66%, which is considered to be acceptable, given the high incidence of false negatives and positives. The result of the evaluation warns health professionals to clinically investigate the suicide risk detected when administering the instrument. Additionally, results highlight the adaptive and therapeutic potential of the reasons to stay alive for the treatment of depressive patients who are contemplating suicide.

RESUMEN: El estudio tuvo como objetivo la validación para Chile de la escala Razones para Vivir (RFL) en una muestra intencionada y consecutiva de 705 consultantes a salud mental en la Región Metropolitana. La RFL evalúa la importancia atribuida a las razones para vivir cuando se piensa en el suicidio. Se analizó la estructura factorial a través de análisis exploratorio y confirmatorio del instrumento original. Se estudió la consistencia interna, la validez de constructo y la validez concurrente y se definieron los parámetros de puntajes. El punto de corte sugerido para Chile es 4,1, lo que significa que bajo este puntaje hay una mayor probabilidad de riesgo suicida. La sensibilidad es del 62,1% y la especificidad, 66%, considerado aceptable, dada la alta incidencia de falsos negativos y positivos. El resultado de la evaluación advierte a los tratantes para indagar clínicamente el riesgo suicida detectado en el momento de aplicar el instrumento. Además, para el tratamiento de pacientes con depresión y riesgo suicida, destaca el potencial adaptativo y terapéutico de las razones para mantenerse con vida cuando se está contemplando el suicidio.

Resumen El presente estudio explora la relación entre las dimensiones de personalidad dependiente y autocrítica, con los déficits emocionales, cognitivos y sociales asociados a la sintomatología depresiva. La muestra del estudio la conformaron 91 estudiantes universitarios pertenecientes a la Pontificia Universidad Católica de Chile y a la Universidad de Chile, con edades comprendidas entre los 18 y 24 años. Para explorar el estado emocional de los participantes se utilizaron los test Inventario de Depresión de Beck (BDI) y Depressive Experiences Question naire (DEQ). Con el fin de evaluar el desempeño cognitivo, se utilizaron: una tarea tipo Stroop y la prueba de Tiempo de Reacción Serial (SSRT), y para evaluar el nivel de mentalización, la tarea de reconocimiento facial Reading the Mind in the Eyes Task (RMET) de Baron-Cohen. Se encontraron correlaciones significativas entre las dimensiones dependencia y autocrítica, la sintomatología depresiva y el desempeño cognitivo de los participantes.

Abstract This study examines the relationship between the dependent and self-criticism Cognitive dimensions of personality with emotional, cognitive and social deficits associated with depres-sive symptoms. The sample included 91 college students, aged 18 to 24, from Pontificia Universidad Católica de Chile and Universidad de Chile. The Beck Depression Inventory (BDI) and the Depressive Experiences Questionnaire (DEQ) tests were used in order to explore the emotional state of the participants. A Stroop task and a Serial Reaction Time (SSRT) test were used in order to assess cognitive performance. In turn, the Reading the Mind in the Eyes Task (RMET) face recognition task, by Baron-Cohen, was used to assess the mentalising capacity. Sig nificant correlations were found between dependency and self-criticism dimensions, depressive symptoms and cognitive performance of the participant.

Resumen Este trabajo presenta el método de Patrones Dinámicos de Vocalización-Silencio (PDVS) para el análisis de la coordinación en la conversación psicoterapéutica. Los objetivos de su desarrollo son dar cuenta empíricamente de los patrones de coordinación vocales en diálogos y examinar la asociación entre la coordinación interaccional y los resultados relacionales positivos. El método PDVS hace posible demostrar que la actividad vocal es un fenómeno no verbal entrelazado con y que influye en el código lingüístico. Los análisis que se pueden realizar a través de este método se ilustran con señales acústicas reales tomadas de segmentos de psicoterapia. El método PDVS es discutido teniendo en cuenta su utilidad para la investigación en psicoterapia, así como para el estudio de la conversación diádica dentro de otros escenarios.

Abstract This paper presents the Vocalization-Silence Dynamic Patterns (VSDP) method for the analysis of coordination in psychotherapeutic conversation. The objectives of its development are to empirically account for vocal coordination patterns in dialogs and to examine the association between interactional coordination and positive relational outcomes. The VSDP method makes it possible to demonstrate that vocal activity is a nonverbal phenomenon entwined with and which influences the linguistic code. The analyses which can be carried out through this method are illustrated with real acoustic signals taken from psychotherapy segments. The VSDP method is discussed, considering its usefulness for psychotherapeutic research as well as the study of dyadic conversation within other scenarios.

Lesbian, gay, bisexual and trans (LGBT) populations have a high prevalence of suicide behaviors. Aim: To review the literature on suicide among LGBT populations. Material and Methods: A systematic review of the scientific literature published between 2004 and 2014 on suicidality among LGBT people was conducted. Forty-five articles were selected for a thematic analysis. Results: The research on suicide among LGBT people has increased during the last decade. The vast majority of studies have been conducted in the U.S. and other English speaking countries. At the same time, in a great part, these studies have been published in journals specializing in mental health and public health of sexual minorities. In general, they provide a significant foundation on protective and risk factors for suicide as well as their epidemiology. Conclusions: The focus of research on suicide among LGBT populations is mainly exploratory. More attention on these at-risk groups is required from the suicide research community in order to provide useful evidence for prevention and development of focalized and effective interventions.

Background: Teaching methods of the undergraduate medical curriculum change considerably from the first years to clinical training. Clinical learning occurs in complex and varied scenarios while caring for patients. Students have to adapt their learning approaches and strategies to be able to integrate theory and clinical practice and become experiential learners. Aim: To identify the strategies used by medical students to learn during the initial clinical years, as reported by students themselves and by their clinical tutors. Material and Methods: We performed eight focus group discussions with 54 students enrolled in years three to six and we interviewed eight clinical tutors. Both focus group discussions and interviews were audio recorded, transcribed and analyzed according to Grounded Theory. Results: Four main themes were identified in the discourse of both students and tutors: Strategies oriented to theoretical learning, strategies oriented to experiential learning, strategies for integrating theory and practice and strategies oriented to evaluation. The mentioning of individual differences was present across the reports of both students and tutors. Conclusions: Students use a rich variety of strategies to face the challenges of clinical learning. Both students and tutors recognize that the learning approaches and strategies vary according the nature of the task and individual differences. The responses of students bring particular knowledge of the approaches used for the theoretical and practical integration and delve into the social dimension of learning.

Background: In Chile, postpartum depression is a prevalent and disabling condition. Universal screening is available but has not been translated into better treatment rates, suggesting the existence of access barriers. Aim: To describe access barriers to postpartum depression treatment in six primary health care clinics in Metropolitan Santiago, Chile. Material and Methods: Twenty women with postpartum depression and 18 primary health care professionals were subjected to a semi-structured interview. A qualitative methodology based on Grounded Theory was used. Results: There are user associated barriers such as lack of knowledge about the disease, a negative conceptualization and rejection of available treatment options. There are also barriers associated with poor network support and some features of the health care system such as long waiting times and lack of coordination between clinical and administrative decisions. Conclusions: Patient and provider related barriers restricting treatment of postpartum depression were identified.

Background: There is growing interest in the treatment and return-to-work of workers with labor related mental illnesses. Aim: To perform a systematic review of practices and interventions that improve return to work. Material and Methods: Systematic literature review. Thirty articles were selected for in- depth analysis. Results: Self efficacy perception, work motivation, a lower age and a better socioeconomic status were identified as worker-related return to work facilitators. Among work environment facilitators, good communication practices, supervisor support, a good assessment and modification of work load, adjustment of expectations, a good relationship between employers and employees and positive work experiences were identified. Treatment may improve return to work using a multidisciplinary approach, reducing stress and identifying psychosocial determinants of mental problems rather than symptoms and providing a timely health care. Conclusions: Return to work of workers with labor related mental illnesses requires a constant sharing of information between health care workers, employers and employees to identify common therapeutic objectives.

Background: In recent years there has been an increase in the prevalence of work-related mental problems, significantly increasing the average annual working days lost because of leave sick. With respect to the later return-to-work, the evidence is categorical in affirming the importance of the successful of this process for the relapse prevention. Furthermore, we note that throughout Latin America the literature and research on interventions to return-to-work is almost absent. Objective: To study the conditions of diagnosis, intervention and return to work that have shown effectiveness from the perspectives and experiences of professionals from a mutuality regarding the intervention to return to work in individuals with problems of mental health of occupational origin. Method: An exploratory-descriptive research was designed using qualitative methodology. Focus groups and interviews to six psychologists, three psychiatrists and four occupational therapists were used. Results: From a descriptive analysis using the procedure of open coding proposed by the Grounded Theory model, five core categories and two transverse phenomena emerged: The tripartite communication and the process oriented by the return to work. The two refer to the process of intervention to return to work as the actors involved in this, whether mutuality or the workers' immediate labor context.

Antecedentes: En los últimos años se ha observado un aumento en la prevalência de problemas mentales de origen laboral, incrementando significativamente el promedio anual de días de trabajo perdidos por reposo. Con respecto al posterior reintegro, la evidencia es categórica en afirmar la importancia de que este sea un proceso exitoso para la prevención de recaídas del trabajador. Asimismo, se constata que a nivel latinoamericano es casi inexistente la literatura e investigación en torno a intervenciones para el retorno laboral. Objetivo: Estudiar las condiciones de diagnóstico, intervención y retorno al trabajo que han mostrado efectividad desde la perspectiva y experiencias de tratantes de una mutualidad respecto de la intervención para el reintegro al trabajo en individuos con problemas de salud mental de origen laboral. Método: Se diseñó una investigación exploratoria-descriptiva, empleando metodología cualitativa. Se utilizaron grupos focales y entrevistas a seis psicólogos, tres psiquiatras y cuatro terapeutas ocupacionales que ejercen sus labores profesionales en una mutual en Chile. Resultados: A partir de un análisis descriptivo, empleando el procedimiento de codificación abierta propuesto por el modelo de Teoría Fundamentada, emergieron cinco categorías centrales y dos fenómenos transversales: La comunicación tripartita y el proceso orientado al reintegro laboral. Ambos hacen referencia tanto al proceso de intervención para el retorno al trabajo como a los actores involucrados en este, ya sea de la mutualidad como también del contexto laboral inmediato de los trabajadores.

Background: The transition to the clinical courses represents a major challenge for medical students who are expected to become experiential learners, able to integrate theory and practice in the context of patient care. There are questions about how students face this challenge. Aim: To understand and compare the perceptions of students and clinical tutors on how medical students learn during the transition to the clinical levels of the curriculum. Material and Methods: We performed eight focus group discussions with 54 students enrolled in years three to seven and we interviewed eight clinical tutors. Both students' focus group discussions and tutors' interviews were audio recorded, transcribed and analyzed according to the Grounded Theory. Results: Nine main themes emerged from the analysis of students' opinions and six from the tutors' views. The following themes were common to both students and educators: educational activities, actors, clinical settings, learning strategies, transition markers and tutor's role. Educators emphasized the importance of curricular courses' design and students, that of emotions, adaptation and self-care strategies, and threats to learning. Conclusions: There is a common core of students' and clinical tutors' perceptions about the relevance of practical activities, social interactions and context in the development of students' learning and adaptation strategies during the transition to the clinical levels of the curriculum. These results are related to social and cultural theories of learning. Thus we propose a model for early clinical learning that might help to stimulate the reflection of students and medical educators regarding clinical learning and contribute to the development of interventions that improve the clinical learning and teaching practices.

Results of a microanalysis of the psychotherapeutic conversation in change and stuck episodes are presented. For the comparison of the verbal communication, the Therapeutic Activity Coding System was applied to a sample of 33 change episodes and 34 stuck episodes, corresponding to 15 therapeutic processes. This system includes five levels of analysis: Basic Forms, Communicative Intentions, Techniques, Domain and Reference. Results show differences in change and stuck episodes. The former are characterized by an assertive speech on the therapists' side, and a more receptive language from the patients, with both actors involved in an active construction of new meanings, and the patients referring to him or herself. In contrast, the language in stuck episodes is less flexible, the use of some therapist techniques is exacerbated and the therapeutic dialogue tends to be less focused on the patient as a reference point.

Se presentan los resultados de un microanálisis de la conversación psicoterapéutica en Episodios de Cambio y de Estancamiento. Se realizó un análisis comparativo de la comunicación verbal en una muestra de 33 Episodios de Cambio y 34 de Estancamiento, correspondientes a 15 procesos terapéuticos, aplicando el Sistema de Codificación de la Actividad Terapéutica. Este sistema distingue cinco niveles de análisis: Formas Básicas, Intenciones Comunicacionales, Técnicas, Dominio y Referencia. Los resultados muestran que los Episodios de Cambio y Estancamiento se distinguen en cuanto a que, en los primeros, predomina un lenguaje más asertivo por parte del terapeuta y más receptivo en el paciente, estando ambos involucrados en la activa construcción de nuevos significados y el paciente centrado en sí mismo. En los segundos se rigidiza el lenguaje, se exacerban algunas técnicas por parte del terapeuta y se tiende a focalizar menos en el paciente como referente del diálogo terapéutico.

The coding system Vocal Quality Patterns (VQP) and a reliability study are presented. The aim was to create a system to identify and codify VQP using a trained hearing assessment. The design was descriptive-exploratory, employing a mixed approach, with a convenience sample of 12 episodes of change extracted from 3 psychotherapies. Qualitative techniques were used to describe 6 VQP: Report, Connected, Affirmative, Reflection, Emotional-Expressive and Emotional-Restrained. Subsequently, by Cohen's kappa coefficient the degree of agreement between independent judges, for the coding of the VQP for a total of 516 segments, corresponding to 457 talking turns, was examined. The system showed high inter-rater reliability and, among its advantages, it presents the possibility of analyzing psychotherapeutic processes, regardless of theoretical orientation or approach, and its applicability to the study of VQP used by therapists and patients.

Se expone el sistema de codificación de Patrones de Cualidad Vocal (PCV) y su estudio de confiabilidad. El objetivo fue crear un sistema que permitiese identificar y codificar PVC por medio de una valoración auditiva entrenada. El diseño fue exploratorio-descriptivo y de enfoque mixto, con una muestra intencionada de 12 episodios de cambio extraídos de 3 psicoterapias. Mediante técnicas cualitativas fueron descritos 6 PCV: Reporte, Conectado, Afirmativo, Reflexión, Emocional-Expresivo y Emocional-Contenido. Posteriormente, por medio del coeficiente kappa de Cohen se analizó el grado de concordancia entre jueces independientes en la codificación de los PCV, sobre un total de 516 segmentos, correspondientes a 457 turnos de habla. El sistema mostró una alta confiabilidad inter-jueces y, entre sus ventajas, la posibilidad de analizar procesos psicoterapéuticos, sin importar su orientación teórica o enfoque, y su aplicabilidad al estudio de los PCV empleados por terapeutas y pacientes.