##plugins.themes.bootstrap3.article.main##


Carlos Marchena Giráldez https://orcid.org/0000-0003-0178-4276

María Xesús Froxán Parga https://orcid.org/0000-0002-6175-4637

Ana Calero Elvira https://orcid.org/0000-0002-1795-3022

Resumen

Las instrucciones son un recurso utilizado por los terapeutas conductuales para asignar las tareas terapéuticas. No obstante, conocemos más sobre el aprendizaje por instrucciones en el laboratorio que en el campo aplicado. El objetivo del estudio es analizar la forma de instruir y revisa el cumplimiento a lo largo del proceso terapéutico. Se analizó la conducta verbal del terapeuta en 211 sesiones de19 casos tratados por 11 terapeutas de orientación conductual (57% hombres y 47% mujeres). Se dividieron las sesiones según la fase en la que se encontraba la intervención y se codificaron utilizando un sistema de categorización validado (SIST-INTER-INSTR). Los resultados muestran que las instrucciones se vuelven menos específica hacia el final de la intervención. Sin embargo, la forma de evaluar el cumplimiento permanece estable. Estos resultados sugieren que la conducta del cliente pasa de estar controlada por las instrucciones a estar controlada por las contingencias naturales. Sin embargo, para asegurarse del mantenimiento del cambio clínico, los terapeutas siguen evaluando y reforzando el cumplimiento hasta el final de la intervención. A pesar de las implicaciones clínicas de los resultados, algunas limitaciones (como, por ejemplo, no tener en cuenta el tipo de tarea terapéutica) requieren ser abordadas en futuros estudios.

##plugins.themes.bootstrap3.article.details##

Keywords

instrucciones, tareas, conducta verbal, cumplimiento, proceso terapéutico

References
Ayllon, T., & Azrin, N. H. (1964). Reinforcement and instructions with mental patients. Journal of the Experimental Analysis of Behavior, 7(4), 327-331. https://doi.org/10.1901/jeab.1964.7-327

Bakeman, R. (2000). Behavioural observation and coding. In H. T. Reis & C. M. Judd (Eds.), Handbook of Research methods in social and personality psychology (pp. 138-159). Cambridge: Cambridge University Press.

Baron, A., & Galizio, M. (1983). Instructional Control of Human Operant Behaviour. The Psychological Record, 33(4), 495-520.

Braem, S., Liefooghe, B., De Houwer, J., Brass, M., Abrahamse, E. L., & Braem, S. (2017). There are limits to the effects of task instructions: Making the automatic effects of task instructions context-specific takes practice. Journal of Experimental Psychology. Learning, Memory, and Cognition, 43(3), 394-403. https://doi.org/10.1037/xlm0000310

Cerutti, D. T. (1994). Compliance with instructions: Effects of randomness in scheduling and monitoring. The Psychological Record, 44, 259-269. https://doi.org/10.1007/bf03395133

Conklin, L. R., Strunk, D. R., & Cooper, A. A. (2018). Therapist behaviours as predictors of immediate homework engagement in cognitive therapy for depression. Cognitive Therapy and Research, 42(1), 16-23. https://doi.org/10.1007/s10608-017-9873-6

Coon, D. W., & Gallagher-Thompson, D. (2002). Encouraging homework completion among older adults in therapy. Journal of Clinical Psychology, 58(5), 549-563. https://doi.org/10.1002/jclp.10032

Cox, D. J., Tisdelle, D. A., & Culbert, J. P. (1988). Increasing adherence to behavioral homework assignments. Journal of behavioral medicine, 11(5), 519-522.

Cronin, T. J., Lawrence, K. A., Taylor, K., Norton, P. J., & Kazantzis, N. (2015). Integrating between-session interventions (Homework) in therapy: The importance of the therapeutic relationship and cognitive case conceptualization. Journal of Clinical Psychology, 71(5), 439-450. https://doi.org/10.1002/jclp.22180

Dattilio, F. M. (2002). Homework assignments in couple and family therapy. Journal of Clinical Psychology, 58(5), 535-547. https://doi.org/10.1002/jclp.10031

DiMatteo, M. R., & DiNicola. D. D. (1982). Achieving patient compliance: The psychology of the medical practitioner’s role. New York: Pergamon.

Follette, W. C., Naugle, A. E., & Callaghan, G. M. (1996). A radical behavioural understanding of the therapeutic relationship in effecting change. Behavior Therapy, 27, 623-641. https://doi.org/10.1016/s0005-7894(96)80047-5

Freeman, A., & Rosenfield, B. (2002). Modifying therapeutic homework for patients with personality disorders. Journal of Clinical Psychology, 58(5), 513-524. https://doi.org/10.1002/jclp.10029

Froján, M. X., Montaño, M., & Calero, A. (2010). therapists’ verbal behaviour analysis: A descriptive approach to the psychotherapeutic phenomenon. The Spanish Journal of Psychology, 13(02), 914-926. https://doi.org/10.1017/s1138741600002560

Froján M. X., & Ruiz, E. M. (2013). Análisis funcional de la interacción terapéutica. Conductual, 1(1), 72-92. http://conductual.com/articulos/Analisis%20funcional%20de%20la%20interaccion%20terapeutica.pdf

Galizio, M. (1979). Contingency-shaped and rule governed behaviour: instructional control of human loss avoidance. Journal of the Experimental Analysis of Behavior, 31, 53-70. https://doi.org/10.1901/jeab.1979.31–53

Garland, A., & Scott, J. (2002). Using homework in therapy for depression. Journal of Clinical Psychology, 58(5), 489-498. https://doi.org/10.1002/jclp.10027.

Hayes, S. C., Brownstein, A. J., Haas, J. R., & Greenway, D. E. (1986). Instructions, multiple schedules, and extinction: distinguishing rule-governed from schedule-controlled behaviour. Journal of the Experimental Analysis of Behavior, 46(2), 137-147. https://doi.org/10.1901/jeab.1986.46-137

Hojo, R. (2002). Effects of instructional accuracy on a discrimination task. The Psychological Record, 52, 493-507. https://doi.org/10.1007/bf03395200

Huppert, J. D., Roth L. D., & Foa, E. B. (2006). The Use of homework in behaviour therapy for anxiety disorders. Journal of Psychotherapy Integration, 16(2), 128-139. https://doi.org/10.1037/1053-0479.16.2.128

Kaufman, A., Baron, A., & Kopp, R. E. (1966). Some effects of instructions on human operant behavior. Psychonomic Monograph Supplements, 7(11), 243-250.

Kazantzis, N., Brownfield, N. R., Mosely, L., Usatoff, A. S., & Flighty, A. J. (2017). Homework in cognitive behavioral therapy. Psychiatric Clinics of North America, 40(4), 625-639. https://doi.org/10.1016/j.psc.2017.08.001

Kazantzis, N., & Deane, F. P. (1999). Psychologists' use of homework assignments in clinical practice. Professional Psychology: Research and Practice, 30(6), 581-585. https://doi.org/10.1037/0735-7028.30.6.581

Kazantzis, N., & Lampropoulos, G. K. (2002). Reflecting on homework in psychotherapy: what can we conclude from research and experience? Journal of Clinical Psychology, 58(5), 577-585. https://doi.org/10.1002/jclp.10034

Kazantzis, N., Whittington, C., Zelencich, L., Kyrios, M., Norton, P. J., & Hofmann, S. G. (2016). Quantity and quality of homework compliance: A meta-analysis of relations with outcome in cognitive behavior therapy. Behavior Therapy, 47, 755-772. https://doi.org/10.1016/j.beth.2016.05.002

Kissi, A., Hughes, S., De Schryver, M., De Houwer, J., & Crombez, G. (2018). Examining the moderating impact of plys and tracks on the insensitivity effect: A preliminary investigation. The Psychological Record, 68(4), 431-440. https://doi.org/10.1007/s40732-018-0286-z

Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159-174. https://doi.org/10.2307/2529310

Lippman, L. G., & Meyer, M. E. (1967). Fixed interval performance as related to instructions and to subjects’ verbalizations of the contingency. Psychonomic Science, 8(4), 135-136. https://doi.org/10.3758/bf03331586

Martínez, H., Ortiz, G., & González, A. (2007). Efectos diferenciales de instrucciones y consecuencias en ejecuciones de discriminación condicional humana. Psicothema, 19(1), 14-22. http://www.psicothema.com/psicothema.asp?id=3322

Martínez, H., & Ribes, E. (1996). Interactions of contingencies and instructional history on conditional discrimination. The Psychological Record, 46, 301-318.

Martínez, H., & Tamayo, R. (2005). Interactions of contingencies, instructional accuracy, and instructional history in conditional discrimination. The Psychological Record, 5(4), 633-646. https://doi.org/10.1007/bf03395531

Mazzullo, J. M., Lasagna, L., & Griner, P. F. (1974). Variations in interpretation of prescription instructions: The need for improved prescribing habits. Jama, 227(8), 929-931. https://doi.org/10.1001/jama.227.8.929

Miller, J. R., Hirst, J. M., Kaplan, B. A., Reed, F. D. D., & Reed, D. D. (2014). Effects of mands on instructional control: A laboratory simulation. The Analysis of Verbal Behaviour, 30(2), 100-112. https://doi.org/10.1007/s40616-014-0015-x

Montaño, M., Martínez, H., Froján, M. X., & Calero, A. (2013). The role of verbal behavior in the analysis of the therapeutic process. Conductual, International Journal of Interbehaviorism and Behavior Analysis, 1(2). http://www.itemadrid.net/pdf/the-role-of-verbal-behavior-in-the-analysis-of-the-therapeutic-process.pdf

Morrison, R. L., & Wixted, J. L. (1989). Social Skills Training. In A. S. Bellack (Ed.), A Clinical Guide for the Treatment of Schizophrenia (pp. 237-261). NY: Plenum Press.

Okamoto, A., Dattilio, F. M., Dobson, K. S., & Kazantzis, N. (2019). The therapeutic relationship in cognitive–behavioral therapy: Essential features and common challenges. Practice Innovations, 4(2), 112-123. https://doi.org/10.1037/pri0000088

Okouchi, H. (1999). Instructions as discriminative stimuli. Journal of the Experimental Analysis of Behavior, 72(2), 205-214. https://doi.org/10.1901/jeab.1999.72-205

Olaff, H. S., & Holth, P. (2020). The emergence of bidirectional naming through sequential operant instruction following the establishment of conditioned social reinforcers. The Analysis of Verbal Behavior, 1-28. https://doi.org/10.1007/s40616-019-00122-0

Ortiz, G. (2010). Precisión de descripciones, retroalimentación y conocimiento de la finalidad de la descripción poscontacto sobre la ejecución, elaboración y transmisión de descripciones. Acta Comportamentalia, 18(2), 189-213.

Ortiz, G., de la Rosa, E., Padilla, R., Pulido, E., & Velez, H. (2008) Efecto de la precisión e historia instruccional en la insensibilidad al cambio contingencial en tareas de igualación de la muestra de primer orden en humanos. Acta Comportamentalia, 16, 167-181.

Ortiz, G., González, A., Rosas, M., & Alcaraz, F. (2006). Efectos de la precisión instruccional y la densidad de retroalimentación sobre el seguimiento instruccional, la elaboración y transmisión de descripciones en tareas de discriminación condicional. Acta Comportamentalia, 14, 103-130.

Ortiz, G., Pacheco, V., Bañuelos, I., & Plascencia, L. (2007). Efecto del contacto con instrucciones, la especificidad e historia instruccional en la insensibilidad al cambio contingencial en tareas de igualación de la muestra de primer orden en humanos. Acta Colombiana de Psicología, 10(2), 107-115.

Podlesnik, C. A., & Chase, P. N. (2006). Sensitivity and Strength: Effects of Instructions on Resistance to Change. The Psychological Record, 56(2), 303-320. https://doi.org/10.1007/bf03395552

Radley, K. C., Dart, E. H., Helbig, K. A., & Schrieber, S. R. (2018). An additive analysis of lag schedules of reinforcement and rules on novel responses of individuals with autism spectrum disorder. Journal of Developmental and Physical Disabilities, 1-14. https://doi.org/10.1007/s10882-018-9606-0

Rosenfarb, I. S. (1992). A Behaviour Analytic Interpretation of the Therapeutic Relationship. Psychological Record, 42, 341-354. https://doi.org/10.1007/bf03399606

Ruiz, E., Froján, M. X., & Calero, A. (2013). Análisis de la conducta verbal del cliente durante el proceso terapéutico. Anales de Psicología, 29(3), 779-790. https://doi.org/10.6018/analesps.29.3.135401

Ruiz, E., Froján, M. X., & Galván, N. (2015). Verbal interaction patterns in the clinical context: A model of how people change in therapy. Psicothema, 27(2), 99-107. https:// doi.org/10.7334/psicothema2014.119

Shelton, J. L., & Levy, R. L. (1981). A survey of the reported use of assigned homework activities in contemporary behavior therapy literature. The Behavior Therapist, 4, 13-14. https://psycnet.apa.org/record/1982-21726-001

Thompkins, M. A. (2002). Guidelines for enhancing homework compliance. Journal of clinical psychology, 58(5), 565-576. https://doi.org/10.1002/jclp.10033

Tsai, M., Kohlenberg, R. J., Kanter, J. W. Kohlenberg, B., Follette, W. C., & Callaghan, G.M. (2009). A Guide to functional analytic psychotherapy. Awareness, courage, love and behaviorism. NY: Springer.

Vargas, I., Pardo, R., Martínez, H., & Froján, M. X. (2017). The therapist’s rule-like verbalizations throughout the clinical process. Universitas Psychologica, 16(1), 25-39. https://doi.org/10.11144/Javeriana.upsy16-1.vtrt

Weiner, H. (1970). Instructional control of human operant responding during extinction following fixed-ratio conditioning. Journal of the Experimental Analysis of Behavior, 13, 391-394. https://doi.org/10.1901/jeab.1970.13-391
Cómo citar
Marchena Giráldez, C., Froxán Parga, M., & Calero Elvira, A. (2020). Instrucciones sobre las tareas terapéuticas y evaluación del cumplimiento durante el proceso terapéutico: análisis de la conducta verbal del terapeuta. Universitas Psychologica, 19, 1-13. https://doi.org/10.11144/Javeriana.upsy19.hica
Sección
Artículos
Artículos más leídos del mismo autor/a