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Browsing by Author "Krause, Mariane"

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A cost-effectiveness evaluation of a home visit program for adolescent mothers
(SAGE PUBLICATIONS LTD, 2009) Aracena, Marcela; Krause, Mariane; Perez, Carola; Jesus Mendez, Maria; Salvatierra, Loreto; Soto, Mauricio; Pantoja, Tomas; Navarro, Sandra; Salinas, Alejandra; Farah, Claudio; Altimir, Carolina
A home visit intervention program for adolescents throughout their pregnancy and during the early stages of motherhood was evaluated. The participants (N = 90) were part of a larger group of adolescents treated in two health centers in a poor neighborhood in Santiago, Chile. The program was carried out by volunteer community health monitors and evaluated through an experimental, randomized, controlled clinical trial. Cost-effectiveness was examined in comparison with standard health care. Results show higher scores for the intervention group on the mothers' mental health and nutritional state, as well as on the children's levels of linguistic development.
An Adjunctive Internet-Based Intervention to Enhance Treatment for Depression in Adults: Randomized Controlled Trial
(2021) Carola Perez, J.; Fernandez, Olga; Caceres, Cristian; Carrasco, Alvaro E.; Moessner, Markus; Bauer, Stephanie; Espinosa Duque, Daniel; Gloger, Sergio; Krause, Mariane
Background:Internet-based interventions promise to enhance the accessibility of mental health care for a greater number of people and in more remote places. Their effectiveness has been shown for the prevention and treatment of various mental disorders. However, their potential when delivered as add-on to conventional treatment (ie, blended care) is less clear.
Analysis of verbalized emotions in the psychotherapeutic dialogue during change episodes
(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2010) Valdes, Nelson; Dagnino, Paula; Krause, Mariane; Perez, Janet C.; Altimir, Carolina; Tomicic, Alemka; de la Parra, Guillermo
As described by many theorists, emotional expressions contribute to the activation and regulation of personal emotional experiences and communicate something about internal states and intentions. These emotional expressions can be observed in the words used in our speech and nonverbal behaviors, even when nonverbal behaviors are synchronized to one's own speech or to the speech of others. Using a quantitative and qualitative methodology, this article reports a classification of verbal emotional expressions of both psychotherapists and patients in change episodes. Assuming that the emotions loaded in linguistic contents are explicit emotions shown by emotion words, this methodology allows for a complete and differentiating assessment of affective qualities in both patients and psychotherapists during the psychotherapeutic dialogue.
BEYOND SURVIVAL: TRACING INDIVIDUAL EMPOWERMENT PROCESSES IN A POOR CHILEAN SETTLEMENT
(WILEY, 2009) Turro, Claudia; Krause, Mariane
Based on the life histories of residents from La Victoria, a poor settlement in Santiago, Chile, this study reconstructed the central biographic elements in individual empowerment processes, linking them with the sociocultural context in which they occurred. Results show the following main characteristics related to individual empowerment: identification with struggle, coping with poverty, a positive attitude towards learning throughout life, a perception of meaning in life, the search for intimacy and the desire to help others. The most empowering contextual elements found are the family models regarding work and the context that the la Victoria settlement offers its inhabitants as a protective space in which a sense of community and participation can develop. (C) 2009 Wiley Periodicals, Inc.
Changing Communities and Increases in the Prevalence of Depression: is there a Relationship?
(2015) Krause, Mariane; Gueell, Pedro; Jaramillo, Andrea; Zilveti, Maya; Pablo Jimenez, Juan; Luyten, Patrick
The article analyses the impact of individualization processes on community-level determinants of health in postmodern societies, taking depression as an example. The analysis shows how the evolution of the broader social context towards forms of organization focused on the individual and on competition in a market economy implies the vanishing of traditional communities and therefore of their health-supportive functions, thus endangering their ability to fulfill the needs of belonging, mutual support, and identity. The analysis also relates this evolution to cultural phenomena and to recent studies about culture-gene coevolution, implying that the effects of community decline are expected to be even greater in collectivist societies. Through its multidimensional conceptual analysis, this paper aims to contribute to further uncovering the interactions of psychological, psychosocial, and biological factors in mental health.
Clarifying for an Other: Six Conversational Practices to Foster Therapeutic Change from a Subjective Change Theory Perspective
(2019) Gaete, Joaquin; Aristegui, Roberto; Krause, Mariane
Drawing from the theory of subjective change in psychotherapy, this theory-building case study examines one successful therapeutic change process. The study characterizes conversational micro-practices featuring in segments of conversation theoretically linked to therapeutic change called change episodes (CE), containing three types of observable generic indicators of change: input, process, and output. For this study the 16 CE containing indicators of the second level (process) were examined. Six conversational practices involving six therapeutic assumptions are presented as a result of the study, which were consequential in discursively accomplishing preferred self-references (PSR) within CE related to process. Given that generating a "subjective theory" about the client's own change process emerges as a byproduct of conversationally clarifying PSR for and with the therapist (Le., intersubjective validation), this study contributes further specifying the theory of subjective change.
Clients', therapists', and observers' agreement on the amount, temporal location, and content of psychotherapeutic change and its relation to outcome
(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2010) Altimir, Carolina; Krause, Mariane; de la Parra, Guillermo; Dagnino, Paula; Tomicic, Alemka; Valdes, Nelson; Carola Perez, J.; Echavarri, Orietta; Vilches, Oriana
Clients', therapists', and observers' identification of change was studied in 27 therapeutic processes, and agreement on the amount, temporal location, and content of change was related to outcome. Results show that clients reported more changes in successful therapies. Client-therapist temporal match of change moments was low irrespective of outcome. Results from all three perspectives were consistent in that manifestation of new behaviors and emotions was the most representative content of change among all therapies. Meanwhile, client-therapist agreement on the frequency of grouped change indicators reported was associated with positive outcome, whereas client-observer agreement was related to negative outcome. Therapists and observers agreed in both successful and nonsuccessful therapies. The relationship between agreement and therapeutic outcome is discussed in relation to each dimension of analysis.
Deconstructing the Therapeutic Alliance: Reflections on the Underlying Dimensions of the Concept
(2011) Altimir, Carolina; Krause, Mariane; Horvath, Adam
The concept of the alliance has received increasing attention from both clinicians and researchers over the past thirty years. Yet it remains only vaguely defined, and its role and effect in therapy continues to be controversial. The goal of this paper is to clarify the meaning of the concept as it is perceived by clients and therapists, and to compare and contrast these perceptions to the notion of the alliance as it is de-facto implemented in research through the most frequently used alliance measures. Our results indicate that clients and therapists pay attention to different aspects of the relationship when they assess the quality of the alliance. The most frequently used measures share some important features but also exhibit significant differences. Some alliance measures attempt to accommodate the differences in the clients´ and therapists´ points of view but others ignore them. In general, these popular measures do not appear to be closely matched to the unique client/therapist perspectives. The impact of the substantial variations between measures and the absence of a clear distinction between the differing perspectives of clients and therapists is discussed.
Del malestar a la depresión: dinámicas en la construcción del significado personal de la experiencia de la depresión
(2020) Vásquez, Daniel ; Altimir, Carolina; Ocampo Lopera, Diana María ; Reinel Pineda, Mahaira Catalina ; Espinosa, Daniel ; Mesa Posada, Camila ; Montenegro, Cristian R. ; Fernández, Olga María ; Krause, Mariane
Objective: To understand the dynamics by which patients signify their depressive experience. Methodology: A qualitative methodology was used, based on the Grounded Theory. Semi-structured interviews were conducted with 10 patients diagnosed with a mood disorder with depressive episode, who had been in a psychotherapy treatment about it. The interviews were analyzed from a descriptive-relational approach, recognizing the main thematic units referred by the participants, and then identifying their relationships and underlying meanings. Results: The meaning of "depression" experience was revealed as a process, named "subjective construction of depression experience", characterized by three moments: (1) "The experience of an unnamed discomfort"; (2) "Anchoring the patient's experience in the word depression"; (3) "Appropriation of depression experience". Conclusion: The depressive experience is presented as a dynamic process of interaction between subjective discomfort and the construction of meanings associated to it. Transitioning from a disconcerting experience observed on their body, mood, and/or their behaviour, to something available to be elaborated discursively, through a semantic reference (depression) that integrates them, originates a process of appropriation about what it implies for each individual to be depressed or have depression.
Dialogues and self-reference: change processes in psychotherapy from speech acts's perspective
(FOUNDATION ADVANCEMENT PSYCHOLOGY, 2009) Aristegui, Roberto; Gaete, Joaquin; Munoz, Gonzalo; Salazar, Jose I.; Krause, Mariane; Vilches, Oriana; Tomicic, Alemka; Ramirez, Ivonne
This article is the result of a research in the frame of therapeutic process, based on Generic Change Indicators (Krause et al., 2006a). Along with Speech Acts Theory (Searle, 2002; Aristegui et al., 2005) it is proposed to use the Dialogical Self Model (Hermans, 1996; Valsiner, 2007) as a suitable device for characterizing and differentiating change and stagnant episodes, in therapeutic conversation. The analysis unit of study is constituted by extracts from two therapies of different theoretical orientation, with change and stagnant episodes previously identified through indicators derived from Subjective Change Theory. The study of change episodes indicates dialogical characteristics of the therapeutic conversation which suppose a self-referential language game where therapist and consultant build a self-position description (subject) that commits with certain ilocutive intentions of action. The study and comparison of change episodes with stagnate episodes integrate in the discussion the distinctions of experience focus in first person and veritative symmetry applied to self referential-performativity and the notions self-dialogicality dialogicality according to the self-dialoglical theory (Hermans, 1996; Valsiner, 2007; Anderson, 1999).
Disonancias, armonías y diálogos entre la investigación y la clínica
(2016) Bergen, Alejandra von; Krause, Mariane
En este trabajo se presenta la conferencia inaugural del 13° Congreso Chileno de Psicoterapia y el 11º Congreso Latinoamericano de la Society for Psychotherapy Research, que se realizó en un formato de diálogo académico. En esta conferencia las autoras -una investigadora (MK) y una clínica (AvB)- discuten la brecha entre la investigación en psicoterapia y el ejercicio clínico, tratando primero los grandes desencuentros o “disonancias” entre la investigación y la clínica, luego de los encuentros, o sintonías, y finalmente de algunas posibilidades para establecimiento de puentes efectivos entre estos ámbitos de acción
Dynamic Patterns in the Voices of a Patient Diagnosed with Borderline Personality Disorder, and the Therapist throughout Long-Term Psychotherapy
(2022) Mellado, Augusto; Martinez, Claudio; Tomicic, Alemka; Krause, Mariane
This case study identified the subjective change in a patient diagnosed with Borderline Personality Disorder (BPD) by analyzing the dynamic patterns that emerged during discursive interaction with her therapist during a successful long-term psychotherapy. A qualitative analysis was conducted by applying the Model of Analysis of Discursive Positioning in Psychotherapy (MAPP), tracking voices and the personal positions of the patient and therapist in all sessions. Subsequently, dynamic patterns were identified and the hypothetical attractors were defined (i.e., the most stable patterns in the interaction of voices) using the Space State Grid (SSG) technique. Five sessions (representing the initial, middle and final stages) were selected to describe the trajectory of the patient's subjective change. These sessions highlight the presence of different attractors and depict the intersubjective interaction that developed during the process. The results suggest a process of subjective transformation from a monological to a dialogical dimension, a change supported by therapeutic interaction based on propositional and reflective discursive aspects; a transition from a state of dissociation of the patient to a reorganization of her subjectivity. The most relevant characteristics of this process as an emergent quality of psychotherapy and its relation to the patient's positive outcomes are discussed.
Effectiveness of Adolescent Identity Treatment (AIT) Versus DBT-A for the Treatment of Adolescent Borderline Personality Disorder
(2022) Schmeck, Klaus; Weise, Sindy; Schlueter-Mueller, Susanne; Birkhoelzer, Marc; Fuerer, Lukas; Koenig, Julian; Krause, Mariane; Lerch, Stefan; Schenk, Nathalie; Valdes, Nelson; Zimmermann, Ronan; Kaess, Michael
Borderline personality disorder (BPD) is among the most severe mental health problems with long-lasting deterioration of functioning. According to a Cochrane review, evidence for methods focused on treatment for adolescent BPD patients is very limited. Aims of the study were to demonstrate the noninferiority of adolescent identity treatment (AIT) compared with dialectical behavior therapy for adolescents (DBT-A), and that intensive early treatment of BPD leads to significant improvement of psychosocial and personality functioning in adolescent patients. In a nonrandomized controlled trial using a noninferiority approach, we compared 37 patients treated with DBT-A with 23 patients treated with AIT. Both treatments included 25 weekly individual psychotherapy sessions and five to eight family sessions. Patients were assessed at four timepoints: baseline, posttreatment, 1- and 2-year follow-up. Primary outcome was psychosocial functioning at 1-year follow-up. We performed both intention-to-treat analyses and per-protocol analyses (completers). Baseline characteristics of both groups were not significantly different except for age and self-injurious behavior. In all, six AIT patients (26%) and 10 DBT-A patients (27%) dropped out of treatment. Both DBT-A and AIT significantly improved adolescents' psychosocial functioning (AIT: d = 1.82; DBT-A: d = 1.73) and personality functioning. BPD criteria and depression were significantly reduced by both treatments. Overall, AIT was found to be not inferior to DBT-A and even more efficient in reducing BPD criteria. Both treatments are highly effective in improving psychosocial functioning and personality functioning in adolescent BPD patients. AIT is a promising approach and not inferior to DBT-A in respect to treatment efficiency.
Evaluación de la efectividad de programas de visitas domiciliarias para madres adolescentes y sus hijos/as
(2011) Aracena, Marcela; Campos, María Silvia; Cuadra, Victoria; Krause, Mariane; Leiva, Loreto; Pérez, Carola; Undurraga, Consuelo; Bedregal, Paula
Background: Home visiting is effective for the promotion and prevention of mother-child health in other countries, especially in vulnerable populations such as pregnant teenagers. Aim: To evalúate the association between receiving a home visiting program duringpregnancy and child development during thefirstyear oflife, maternal mental health, perception of social support and school attendance. Material and Methods: Cross sectional assessment of 132 teenage mother-sibling pairs. Ofthese, 87 received home visits and 45 were randomly assigned to a control group. The assessed variables were maternal mental health, perception of social support, Ufe satisfaction, incorporation of mothers to school after delivery, child development and frequency of child abuse and neglect. Results: Mothers that received home visits had a better mental health and went back to school in a higherproportion. No significant differences between groups were observed on perception of social support or child development. Conclusions: These results suggest the effectiveness of domiciliary visits performed by non-professionals, to improve mental health and social integration of teenage mothers.
Evolucion del Cambio en el Proceso Psicoterapeutico
(Sociedad Chilena de Salud Mental, 2005) Krause, Mariane; Dagnino, P.; Raul Riquelme, Edgardo Thumala
Failure in psychotherapy: a qualitative comparative study from the perspective of patients diagnosed with depression
(2022) Suárez-Delucchi, Nicolás ; Keith-Paz, Alex ; Reinel, Mahaira ; Fernandez, Sofía ; Krause, Mariane
This qualitative study's objective was to understand how failure in psychotherapy develops from depressed patients' perspective. Forty-seven patients were interviewed after brief psychotherapy. Data analysis was conducted according to Grounded Theory. Patients evaluated their own psychotherapies' outcome according to their subjective criteria. Then, negative, positive and mixed-results evaluations were compared in the main categories. Results showed that patients reporting negative evaluations considered null or adverse outcomes as failure. Distrust in their psychotherapists (both as persons and professionals) developed in early stages of the process and was apparently hard to revert. This early onset of distrust led patients to a lack of collaboration and an unreceptive attitude. They perceived their psychotherapist as not understanding, distant, and uninterested, losing focus on relevant problems and not providing new information. The relationship was experienced as uncomfortable and distant, and sometimes became harmful. Therefore, distrust led patients to regard their psychotherapies as an unhelpful experience, in contrast to what occurred in patients with positive or mixed results evaluations. Conclusions contribute to a clarification of how patients conceptualize failure and suggest reevaluating the relevance of their perspective, which seems not to be fully reflected in current outcome measures. Clinicians should consider building trust as a baseline and encourage patients to disclose even the earliest negative feelings about treatment and psychotherapist
Feasibility and effectiveness of an Internet-based program for the prevention and early intervention of depression inInternet adolescents
(2022) Espinosa-Duque, Daniel; Fernandez, Mauricio; Paula Ruiz, Maria; Carlos Jaramillo, Juan; Moessner, Markus; Bauer, Stephanie; Krause, Mariane
Background: the high prevalence of depression in adolescence and its serious consequences, associated with its lack of detection and treatment, stimulate interest in research regarding its early prevention and intervention. Interventions based on information and communication technologies (ICT), given their flexibility and capacity for dissemination, represent innovative opportunities; however, in Latin America there is little evidence on their impact and efficacy. Objective and Methods: a quasi-experimental quantitative pilot study was carried out to evaluate the feasibility, through the variables of use and acceptability, and the estimated effect of the Internet-based program "Cuida tu animo", in 215 adolescents (103 active group, 112 control group) from two educational institutions. The adolescents' interactions with the program, its use-acceptability, and the level of depressive symptomatology and other related aspects were evaluated. Results: the adolescents report high acceptance and very moderate use of the Program. They point out that the program allowed them to learn about depression and early detection of risk; also, they recommend increasing the interactivity of the web platform, designing more diverse and entertaining content, and increasing the presence of the intervention. Conclusions: Internet-based programs such as Cuida tu animo can be a favorable complement for the prevention and early intervention of depression in adolescents. Considering the difficulty in relating the estimation of the Program's effect with its use, it is recommended that future studies include a design that permits associating the use indicators with the outcome indicators (dose-effect).
"I am strong and I can get on with my life": The subjective experience of recovery of patients treated for depression
(2022) Fernandez, Olga; Altimir, Carolina; Reinel, Mahaira; Duarte, Javiera; Krause, Mariane
Depression has a high prevalence throughout the world, and its management and recovery still constitute a challenge for mental health professionals. Objective : The aim of the study was to characterize the subjective experience of recovery from depression based on the perspective of those who suffer from it.
Identification of Dynamic Patterns of Personal Positions in a Patient Diagnosed With Borderline Personality Disorder and the Therapist During Change Episodes of the Psychotherapy
(2022) Mellado, Augusto; Martinez, Claudio; Tomicic, Alemka; Krause, Mariane
Personal positions and voices of a patient diagnosed with borderline personality disorder (BPD) and the therapist during long-term psychotherapy were studied aiming to find differences in the patterns formed in these aspects of subjectivity according to the level of elaboration of the change episodes achieved by the patient. This case study considered a stage of qualitative analysis where change episodes of the patient were traced through the Change Episodes Model. Later, through the Model of Analysis of Discursive Positioning in Psychotherapy (MAPP), the voices and personal positions of the patient and her therapist were identified in each of the change episodes. In the stage of quantitative analysis, dynamic patterns in the voices and personal positions were established, accounting for hypothetical attractors using the Space State Grid (SSG) technique in each of the three different levels of subjective elaboration that constitute the change episodes. The results established differentiated dynamic patterns in the change episodes, coherent with the patient's change process, and formation of propositive/reflective specific patterns as the patient evolved in the three different levels of subjective elaboration. The above suggests that a subjective transformation process is displayed, and this is manifested in the different voices and personal positions that emerged as the change episodes evolve. The identified dynamic patterns can be considered nonlinear and emergent subjective exchanges between the patient and the therapist throughout the psychotherapy.
Language and therapeutic change: A speech acts analysis
(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2008) Reyes, Lucia; Aristegui, Roberto; Krause, Mariane; Strasser, Katherine; Tomicic, Alemka; Valdes, Nelson; Altimir, Carolina; Ramirez, Ivonne; De La Parra, Guillermo; Dagnino, Paula; Echavarri, Orietta; Vilches, Oriana; Ben Dov, Perla
Drawing on the speech acts theory, a linguistic pattern was identified that could be expected to be associated to therapeutic change, characterized by being uttered in the first person singular and present indicative, and by being self-referential in its propositional content. The frequency of the pattern was examined among verbalizations defined as change moments in three therapies with different theoretical orientation. Results show that the majority of change moments have the specified pattern, and that this pattern is significantly more frequent in change moments than in random non-change-related verbalizations, and so, it does not pertain to therapeutic conversation in general. Implications are discussed concerning the possibility of using the linguistic pattern as an additional and complementary criterion in the identification of moments of change in the therapeutic process.

Browsing by Author "Krause, Mariane"

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