Terapia comportamental abrangente: caracterização e efeitos de seu treinamento sobre processos e resultados clínicos

Abstract

The historical movements that gave rise to the current forms of behavior-analytic therapy in Brazil are diverse, resulting in a plurality of practices that make all attempts to define the identity of these therapies challenging. Practices that differ widely both in terms of their procedures and in the concepts that underlie their analyses are grouped under the same label. One way to face this challenge is to define specific work guidelines in a distinct therapeutic model compatible with the general principles of behavior-analytic therapy. Comprehensive Behavior Therapy (Terapia Comportamental Abrangente - TCA) emerged in this context in 2018. The first part of the present study presents the characterization of TCA. Its prescriptive elements are based on other areas of Psychology that investigate what makes people feel satisfied with their own lives, especially in Positive Psychology. The explanation of the change processes necessary to achieve therapeutic goals emphasizes verbal behavior as relational responding and the reversal of aversive contingencies effects. Clinical procedures prioritize shaping and modeling of comprehensive verbal repertoires by way of the natural therapeutic dialogue and the directed instruction of out-of-office social interactions. Along with these working guidelines, the basic principles of TCA also direct ways in which therapists can develop themselves both personally and professionally. The second part of this work consists of an experimental clinical research by which the effect of TCA guidelines training on the practice of behavior-analytic therapists was observed. The independent variable was characterized in two ways: comparing therapists who were adept to TCA since its conception (experienced therapists) with therapists who were previously unfamiliar with it (apprentice therapists), and comparing the latter's practice before and after formal TCA training. Therapists from both groups worked with a single client each for up to ten sessions, and apprentice therapists received training before the fifth one. The behavior of therapists in each session was categorized using the Multidimensional System for Coding Behavior in Therapeutic Interaction (SiMCCIT) and evaluated separately by an instrument assessing compatibility with TCA guidelines. Furthermore, therapeutic results were measured using the Outcome Questionnaire (OQ-45.2). The compatibility instrument distinguished experienced therapists from apprentices, although training effects were not observed. All therapists achieved improvements with their clients, and the results of apprentice therapists were overall superior. The results of apprentice therapists fluctuated less after training, and adherence to TCA guidelines concerning analyses and interventions focused on the clients' comprehensive repertoires were the best results predictors, especially in measures associated with interpersonal relationships. The implications for the inclusion of TCA in the set of Brazilian behavior-analytic therapies and the subsequent steps for the development of evidence that support its practice are discussed