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Estar, Regulação De Necessidades Psicológicas E Processo Psicoterapêutico: Integrando a Perspetiva Dos Pacientes

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Estar, Regulação De Necessidades Psicológicas E Processo Psicoterapêutico: Integrando a Perspetiva Dos Pacientes UNIVERSIDADE DE LISBOA Faculdade de Psicologia Bem ‑estar, regulação de necessidades psicológicas e processo psicoterapêutico: integrando a perspetiva dos pacientes Catarina Marques da Silveira Vaz Velho Orientador: Prof. Doutor António José dos Santos Branco Vasco Tese especialmente elaborada para a obtenção do grau de Doutor no ramo de Psicologia, especialidade de Psicologia Clínica 2016 UNIVERSIDADE DE LISBOA Faculdade de Psicologia Bem‑estar, regulação de necessidades psicológicas e processo psicoterapêutico: integrando a perspetiva dos pacientes Catarina Marques da Silveira Vaz Velho Orientador: Prof. Doutor António José dos Santos Branco Vasco Tese especialmente elaborada para a obtenção do grau de Doutor no ramo de Psicologia, especialidade de Psicologia Clínica Júri Presidente: Doutora Isabel Maria de Santa Bárbara Teixeira Nunes Narciso Davide, Professora Associada e Vice-Presidente do Conselho Científico da Faculdade de Psicologia da Universidade de Lisboa Vogais: – Doutora Margarida Maria Baptista Mendes Pedroso de Lima, Professora Associada Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra; – Doutor Daniel Cunha Monteiro de Sousa, Professor Auxiliar Departamento de Psicologia Clínica e da Saúde do ISPA - Instituto Universitário de Ciências Psicológicas, Sociais e da Vida; – Doutor António José dos Santos Branco Vasco, Professor Catedrático Faculdade de Psicologia da Universidade de Lisboa; – Doutor Nuno Miguel Silva Conceição, Professor Auxiliar Convidado Faculdade de Psicologia da Universidade de Lisboa. 2016 “BEM-ESTAR, REGULAÇÃO DE NECESSIDADES PSICOLÓGICAS E PROCESSO PSICOTERAPÊUTICO: INTEGRANDO A PERSPETIVA DOS PACIENTES” Agradecimentos Como agradecer gestos com palavras? Às pessoas que realizaram processos psicoterapêuticos e que colaboraram nesta investigação com as suas reflexões, experiências e conhecimento sobre a Psicoterapia, o meu mais profundo agradecimento. Agradeço os contributos fundamentais, a honra que me deram em partilharem comigo as suas histórias e os seus saberes de experiên- cia feitos e as suas palavras, que me acompanharam ao longo de todo este processo. Aos terapeutas que participaram agradeço a disponibilidade e interesse que ma- nifestaram desde o primeiro momento e todos os contributos que permitiram a realiza- ção deste trabalho mas que são como o trabalho de bastidores, fundamental mas não visível. Muito obrigada pela vossa confiança. Ao meu Professor e Orientador Prof. Doutor António Branco Vasco nem sei como começar a agradecer. Aquilo que normalmente se diz nestas ocasiões, aquilo que é aceite pelo protocolo académico não chega para exprimir tudo o que sinto. Nalguns momentos não ter palavras é melhor do que ter rios de palavras. Agora precisava de um Tejo. Obrigada, desde as primeiras aulas sobre a psicoterapia até hoje, pelos nossos diálogos ao longo das décadas, por tornar tantas coisas muito mais interessantes, mais poéticas e mais livres. À Profª Doutora Assunção Folque, à Profª Doutora Luana Cunha Ferreira e ao Dr. Osvaldo Santos agradeço os mundos qualitativos que me apresentaram. Nunca mais nada será igual. Aos meus colegas. À minha família grande. À minha família pequena. À minha Mãe. Aos meus Amigos de todas as horas e aos amigos destas horas todas. À Luísa, à Sofia, à Susana, ao Hans, à Isabel, ao Nuno, à Fernanda, ao Osvaldo, ao Miguel, à Catarina, à Marta. À Poeta T. Mané. À XumXum, por tudo. Ao Manuel, que é também o meu Amor. AGRADECIMENTOS i “BEM-ESTAR, REGULAÇÃO DE NECESSIDADES PSICOLÓGICAS E PROCESSO PSICOTERAPÊUTICO: INTEGRANDO A PERSPETIVA DOS PACIENTES” Resumo O presente estudo insere-se no domínio da Psicologia Clínica, mais especifica- mente, no domínio da Psicoterapia, particularmente no que diz respeito à relação en- tre a Psicoterapia e o Bem-Estar. Pretende-se explorar e compreender como é que, na perspetiva de ex-pacientes, o processo psicoterapêutico pode contribuir para o Bem- -Estar e para identificar dimensões do Bem-Estar que são relevantes para descrever as suas experiências de psicoterapia. Parte-se do pressuposto da centralidade das pessoas que fizeram processos psi- coterapêuticos como informantes privilegiados acerca das suas experiências de psi- coterapia bem como do que sentem e identificam como Bem-Estar. Partindo de uma perspectiva qualitativa e usando a Grounded Theory, analisaram-se os contributos de 16 ex-pacientes de psicoterapia (com perspetivas teóricas diversas), contributos es- tes recolhidos através de entrevistas semiestruturadas e de posteriores feedbacks. A amostra foi recolhida entre ex-pacientes de psicoterapia, realizada em contexto de prá- tica privada. Os resultados revelam que os participantes no estudo refletem sobre o contri- buto positivo do processo psicoterapêutico na construção do seu Bem-Estar de modo reflexivo e crítico mostrando como este processo é simultaneamente uma experiência exigente e difícil e um processo profundamente transformador que não termina com o fim da psicoterapia. Na experiência de Bem-Estar, os participantes valorizam a im- portância da paz e serenidade, da felicidade, da liberdade e da abertura, o ter relações significativas com os outros e o sentir-se centrado no presente, retirando prazer no seu dia a dia. Ao refletirem sobre o modo como a psicoterapia aumentou o Bem-Estar, os participantes referem que tal aconteceu porque a psicoterapia promoveu um conjun- to de melhorias sintomáticas mas também e mais aprofundadamente um conjunto de melhorias na relação com outras pessoas e na relação consigo próprios. Em relação às melhorias na relação consigo próprios, as experiências de aceitação, compreensão e RESUMO ii “BEM-ESTAR, REGULAÇÃO DE NECESSIDADES PSICOLÓGICAS E PROCESSO PSICOTERAPÊUTICO: INTEGRANDO A PERSPETIVA DOS PACIENTES” atribuição de sentido, de desenvolvimento de si próprios, da sua confiança em si, no seu valor e nas suas competências para lidarem consigo mesmos, são experienciadas como centrais. O modo como a relação psicoterapêutica, bem como as contribuições ativas dos terapeutas e as suas próprias contribuições no processo terapêutico interagem são aprofundadas na reflexão dos participantes. São sublinhadas por um lado, a impor- tância de a atividade e diretividade do terapeuta não colocar em causa a liderança do paciente do processo e por outro a consciência reflexiva dos participantes da impor- tância da qualidade da sua participação. Todos estes aspetos reafirmam a importância de se conhecer a perspectiva dos ex-pacientes e de considerar a sua reflexividade na compreensão do Bem Estar e da prática clínica. Palavras-chave Psicoterapia / Bem Estar / Perspetiva dos Pacientes / Necessidades psicológicas / Modelo de Complementaridade Paradigmática PALAVRAS-CHAVE iii “BEM-ESTAR, REGULAÇÃO DE NECESSIDADES PSICOLÓGICAS E PROCESSO PSICOTERAPÊUTICO: INTEGRANDO A PERSPETIVA DOS PACIENTES” Abstract Well-being, psychological needs and the therapeutic process: integrating the client’s perspective This study in the field of clinical psychology, more specifically in psychotherapy, deals with the relationship between psychotherapy and well-being. The aim of the re- search is to explore and understand how, from the perspective of former patients, the psychotherapeutic process has contributed to their well-being, as well as to identify significant dimensions of well-being that characterize the experience of psychotherapy. The study also intends to link the aspects identified with the proposals of the Paradig- matic Complementarity Model. This study sees patients as privileged informers regarding their own psychother- apy experience as well as how they experience and identify well-being. Using the qual- itative methodology of Grounded Theory, we analyzed the contributions of 16 former patients of different psychotherapists from different psychotherapeutic schools. These accounts were collected through semi-structured interviews and subsequent feedback. The sample was selected from former patients of a private psychotherapy practice. The results showed that these participants reflected on the positive contribution of the psychotherapeutic process in enhancing their well-being in a mindful and critical way. The findings show that the therapeutic process is both a difficult experience and a profoundly transformative process that does not finish with the end of the therapy. In their experience of well-being, participants described valuing the importance of: peace and serenity; happiness; freedom and openness; significant relations with others; and being centered on the present time and experiencing some pleasure in their daily life. Participants maintained that the psychotherapy had increased their well-being, not only due to improvement in symptoms but, more significantly and at a deeper level, they talked about how it led to improvements both in their relationship with themselves and ABSTRACT iv “BEM-ESTAR, REGULAÇÃO DE NECESSIDADES PSICOLÓGICAS E PROCESSO PSICOTERAPÊUTICO: INTEGRANDO A PERSPETIVA DOS PACIENTES” with others. Central aspects of the improvements in participants’ relationships with themselves include: the sense of acceptance, understanding and meaning making, in their self-development, and self-competency in dealing with themselves. The interac- tion between the therapists’ active involvement and the patients’ own contributions to the process, were subject to deep reflection by the participants. What the participants highlighted were, on one hand, the importance of the therapists’ activity and directivity without compromising the patients’ leadership
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