Papers by Paula Errázuriz
Journal of Clinical Child & Adolescent Psychology, 2013
Objective-This study examined changes in the therapeutic alliance and in self-reported anxiety ov... more Objective-This study examined changes in the therapeutic alliance and in self-reported anxiety over the course of 16 weeks of manual-based family treatment for child anxiety disorders. Method-86 children (51.3% female; aged 7.15 to 14.44; 86.2% Caucasian, 14.8% minority) with a principal diagnosis of separation anxiety disorder, generalized anxiety disorder, and/or social phobia, and their parents, received family treatment for anxiety disorders in youth. Child, therapist, and parent ratings of therapeutic alliance and child ratings of state anxiety were measured each session. Latent difference score growth modeling investigated the interacting relationship. Results-Therapeutic alliance change, as rated by the mother and by the therapist, was a significant predictor (medium effect) of latter change in child anxiety (with greater therapeutic alliance leading to later reduction in anxiety). However, changes in child-reported anxiety also predicted latter change in father-and therapist-reported alliance (small-to-medium effect). Prospective relationships between child-reported therapeutic alliance and child-reported symptom improvement were not significant. Conclusions-Results provide partial support for a reciprocal model in which therapeutic alliance improves outcome, and anxiety reduction improves therapeutic alliance. Keywords Alliance; child anxiety; family treatment; process Studies have reported that therapeutic alliance components can be predictive of a favorable treatment outcome in adults and youth across various treatment modalities (see Horvath &
PsycTESTS Dataset, 2020
Se presenta la adaptación al español y validación en una muestra chilena por conveniencia de la E... more Se presenta la adaptación al español y validación en una muestra chilena por conveniencia de la Escala de Auto-Ocultamiento (Self-Concealment Scale) de Larson y Chastain (1990). Participaron 193 adultos (100 hombres y 93 mujeres), con una edad media de 28,39 años (DE = 8,75), distribuidos en 3 grupos de la Región Metropolitana: 53 estudiantes universitarios, 64 estudiantes de un instituto de capacitación y 76 profesionales y dirigentes de una fundación sin fines de lucro. Para examinar la validez de la versión en español, se realizó un análisis factorial confirmatorio. Los resultados permiten inferir que la versión en español tiene propiedades psicométricas satisfactorias, presentando una alta consistencia interna (α = 0,85) y una aceptable estabilidad a través del tiempo (r = 0,74). Al igual que la escala original, la versión en español validada resultó ser unidimensional y las puntuaciones de la escala se correlacionaron directamente con sintomatología depresiva y ansiosa, medida a través del Outcome Questionnaire 30.2 (OQ 30.2). Estos hallazgos avalan el uso de la versión en español de la EAO en población de habla hispana. Palabras clave: escala de auto-ocultamiento, secreto, adaptación, validación, estudio metodológico This paper presents a Spanish-language adaptation of the Self-Concealment Scale (SCS) by Larson and Chastain (1990) and its validation in a Chilean convenience sample. The participants were 193 adults (100 men and 93 women) with a mean age of 28.39 years (SD = 8.75), grouped in 3 subsamples from the Metropolitan Region: 53 college students, 64 students from a technical institute, and 76 professionals and community leaders of a non-profit organization. In order to examine the validity of the Spanish-language version of the SCS, a confirmatory factor analysis was conducted. Results suggest that the Spanish-language version of the SCS has satisfactory psychometric properties, showing high internal consistency (α = 0.85) and acceptable stability over time (r = 0.74). Like the original scale, the validated Spanish-language version proved to be unidimensional and its scores correlated directly with anxious and depressive symptomatology as measured with the Outcome Questionnaire 30.2 (OQ 30.2). These findings support the use of this version of the SCS with Spanish-speaking population.
Shortened Outcome Questionnaire--Spanish Version
Journal of Clinical Psychology, 2018
Objective Because of the importance of the therapeutic alliance across psychotherapeutic treatmen... more Objective Because of the importance of the therapeutic alliance across psychotherapeutic treatments, it is important to study variables that predict the development of a positive therapeutic alliance. This study investigates if different levels of gender, age, and income match between therapists and clients predict early development of the therapeutic alliance. Method The sample consisted of 28 therapists and 547 adult clients receiving individual psychotherapy for depressive symptoms. There
Journal of Consulting and Clinical Psychology, 2019
It has been widely demonstrated that the process of change many patients undergo in therapy is no... more It has been widely demonstrated that the process of change many patients undergo in therapy is not linear. Some patients benefit greatly from large sudden improvements, commonly referred to as "sudden gains." It is less clear whether certain baseline characteristics make patients more prone to displaying sudden gains, as well as what mechanisms are responsible for the lasting effects of sudden gains. Method: In a sample of 547 patients receiving treatment in an outpatient mental health clinic, a machine learning approach was used to search for potential predictors of sudden gains. A within-patient mediation model was used to investigate whether alliance serves as a mechanism underlying the sustained effect of sudden gains. Results: Twelve percent of patients showed sudden gains. Consistent with previous studies, no robust predictors of sudden gains were found, even when using an approach capable of evaluating the contributions of multiple predictors and their interactions. A significant within-patient mediation model was found, according to which sudden gains predict subsequent strengthening in alliance, which in turn predict subsequent improvement in life satisfaction and psychological dysfunction. These findings support the proposed theoretical framework whereby alliance is an important ingredient of an upward spiral that may results in sustained sudden gains. Conclusions: The findings provide first evidence of the presence of an ingredient responsible for the sustained effect of sudden gains, using a within-patient mediation model. The findings support the important role alliance may play in the consolidation and subsequent expansion of the effect of sudden gains. What is the public health significance of this article? Findings suggest that the alliance may act as an important ingredient in sustaining large sudden improvements (commonly referred to as "sudden gains") over time. The analyses support the conceptual model according to which sudden gains drive subsequent strengthening in alliance, which in turn serves to improve life satisfaction and psychological dysfunction.
Counselling and Psychotherapy Research, 2017
Objective: The article examines the role of family income on the relationship between change in s... more Objective: The article examines the role of family income on the relationship between change in symptomatic burden and change in life satisfaction during six sessions of naturalistically delivered individual psychotherapy. Method: Five hundred and thirty-two clients receiving psychotherapy were assessed at baseline and on a session-to-session basis with the OQ-30.2 and with a life satisfaction questionnaire. Data were analysed using a bivariate latent class model with structured residuals that included cross-lagged and autoregressive components between residual scores at each time point. Adjusted family income and a binary low versus high-income group variable were added as exogenous baseline covariates at different stages of the analyses. Results: Regardless of income level, clients show improvement in psychological distress and life satisfaction as a function of time during treatment. Initial levels and improvement in life satisfaction are related to initial levels and improvement in psychological distress, and lower family income is related to slower decreases in psychological distress. When the whole sample is analysed, psychological distress and life satisfaction show reciprocal prospective relationships at the within-person level. When models are estimated by income group, casual relationships at the within-person level vary as a function of income. Conclusion: Family income level appears to play a significant role in the relationship between symptom improvement and life satisfaction during psychotherapy.
Journal of Clinical Psychology, 2019
The primary aim of this study is to improve our understanding of therapists' experience of a "dif... more The primary aim of this study is to improve our understanding of therapists' experience of a "difficult patient" and consider the different variables involved in this label. What makes a patient be perceived as difficult by a therapist in public health services? Results of our analysis of 10 qualitative semistructured interviews of therapists working in public health service in Chile indicated that therapists' perceptions of a "difficult patient" depend on variables that go beyond the patient's intrinsic characteristics, including patients' negative attitude toward the therapist and treating team, patients' negative effects on therapists, and a difficult treatment context (e.g., work overload, scarce resources, limited number, and frequency of sessions). We illustrate the interaction of these dimensions and focus on the impact of the treating context on therapists' experience of a "difficult patient" through the case of a therapist working with a patient with complex depression in the public health system of Chile.
Journal of consulting and clinical psychology, 2018
Our objective was to assess low-cost and feasible feedback alternatives and compare them to Lambe... more Our objective was to assess low-cost and feasible feedback alternatives and compare them to Lambert's OQ feedback system. We also studied patient, therapist, and process characteristics that could moderate the effect of feedback on outcome, session attendance, and alliance. A total of 547 patients, 75% female, average age 41 (SD = 13), 95% Latino, treated in an outpatient individual psychotherapy setting in Chile were randomly assigned to five feedback conditions: no feedback, feedback on symptomatology, feedback on the alliance, feedback on both symptomatology and alliance, and Lambert's OQ progress feedback report. The measures included the Outcome Questionnaire and the Working Alliance Inventory. We also had follow-up interviews with therapists. We found through multilevel modeling that feedback had no effect on outcome, session attendance, and alliance. Contrary to previous findings, these results were maintained even when focusing only on patients "not-on-track.&qu...
Cognitive Therapy and Research, 2017
Frontiers in Psychology, 2017
This study assessed the psychometric properties of a Spanish version of the Shortened Outcome Que... more This study assessed the psychometric properties of a Spanish version of the Shortened Outcome Questionnaire (OQ-30.2, Lambert et al., 2004) validated with a sample of 546 patients in an outpatient mental health clinic and 100 non-clinical adults in Chile. Our results show that this measure has similar normative data to the original measure, with a cutoff score for the Chilean population set at 43.36, and the reliable change index at 14. This Spanish OQ-30.2 has good internal consistency (α = 0.90), has concurrent validity with the Depressive, Anxious, and Somatoform disorders measuring scale (Alvarado and Vera, 1991), and is sensitive to change during psychotherapy. Consistent with previous studies, factorial analyses showed that both, the one-factor solution for a general scale and the three-factor solution containing three theoretical scales yielded poor fit estimates. Overall, our results are similar to past research on the OQ-45 and the OQ-30. The short version has adequate psychometric properties, comparable to those of the OQ-45, but provides a gain in application time that could be relevant in the setting of psychotherapy research with large samples, frequent assessments over time, and/or samples that may require more assistance completing items (e.g., low-literacy). We conclude that this measure will be a valuable instrument for research and clinical practice.
Journal of consulting and clinical psychology, 2017
Advanced statistical tools have created the opportunity to systematically examine the effect of e... more Advanced statistical tools have created the opportunity to systematically examine the effect of early trajectories in predictors of therapeutic change, such as early alliance development patterns, on outcome. To date, however, these methods have been used almost exclusively to examine the effect of the development of early symptoms on later ones. Development patterns of alliance early in treatment, and their association with treatment outcome, have received much theoretical attention, but few systematic examinations have been conducted so far. We integrated exploratory cluster analysis with the accumulated theoretical and empirical knowledge on patterns of alliance development to identify distinct patterns of early alliance development across the 1st 4 sessions of treatment in a sample of 166 patients receiving psychotherapy. Three patterns of early alliance development were identified: early gradual strengthening, early repaired rupture, and early unrepaired rupture. The gradual st...
Journal of Child and Family Studies, 2016
The purpose of this study was to qualitatively assess the implementation of the Triple P program ... more The purpose of this study was to qualitatively assess the implementation of the Triple P program in Chile from the perspective of users. The design consisted of three focus groups with a total of 34 parents as participants. The information collected was analyzed according to the principles of grounded theory. The main findings from the qualitative analysis were that parents consider that their participation helped them improve their parenting skills, improve communication among caregivers, and decrease parental stress. In turn, they reported positive changes in the behavior of their children and showed a paradigm shift regarding parenting. It is concluded that from the parents' perspective the program objectives were met, which coincides with the results of the quantitative evaluation. The Triple P program seems to respond to the needs of Chilean parents and its implementation could help reduce maltreatment and improve mental health of children and their parents. It is necessary to generate more research on the implementation of Triple P in Chile and to adjust the program to this context.
Revista médica de Chile, 2015
Mental health financing in Chile: a pending debt In spite of the high prevalence of mental health... more Mental health financing in Chile: a pending debt In spite of the high prevalence of mental health disorders in Chile, there is a significant financing deficit in this area when compared to the world's average. The financing for mental health has not increased in accordance with the objectives proposed in the 2000 Chilean National Mental Health and Psychiatry Plan, and only three of the six mental health priorities proposed by this plan have secure financial coverage. The National Health Strategy for the Fulfilment of Health Objectives for the decade 2011-2020 acknowledges that mental disorders worsen the quality of life, increase the risk of physical illness, and have a substantial economic cost for the country. Thus, this article focuses on the importance of investing in mental health, the cost of not doing so, and the need for local mental health research. The article discusses how the United States is trying to eliminate the financial discrimination suffered by patients with mental health disorders, and concludes with public policy recommendations for Chile.
Journal of Counseling Psychology, 2015
Although the alliance-outcome association is one of the most consistent findings in psychotherapy... more Although the alliance-outcome association is one of the most consistent findings in psychotherapy research, it is also highly heterogeneous. Little is known about the factors explaining this variability, and consequently there is a lack of adequate knowledge about how to utilize this association to improve treatment. The present study had the following objectives: (a) to examine the associations between within-and between-individual variability in alliance and outcome, controlling for previous symptomatic levels; (b) to examine the duration of the alliance-outcome association; and (c) to examine potential moderators of the alliance-outcome association. A total of 547 patients treated in a primary care psychotherapy setting in Chile were randomly assigned to 5 feedback conditions. The alliance-outcome association was analyzed using multilevel models, disentangling changes in alliance within-individuals from alliance between-individuals. Patient and therapist characteristics were examined as potential moderators. Findings suggest that patients who reported a better early alliance also reported a better outcome. Furthermore, patients reporting time-specific improvement in alliance also reported a greater reduction in symptoms. The unique effect of alliance on outcome at one point in time is maintained for a period of 2 weeks. Patients with more severe symptoms and longer treatments benefited more from a good alliance. Therapists identifying themselves as more integrative in their treatment orientation were able to better utilize good alliances for treatment success. Finally, the size of the alliance-outcome association can be manipulated by feedback to therapists.
Psychology and Psychotherapy: Theory, Research and Practice, 2014
Objectives. This study examined the relationship between patients' object relations and interpers... more Objectives. This study examined the relationship between patients' object relations and interpersonal process in psychotherapy. Namely, we tested the hypothesis that the quality of patients' object relations is positively associated with both patient-and therapist-rated alliance quality. Design. Psychotherapy was administered naturalistically, with quantitative data collection before and during treatment. Methods. Participants included 73 adult outpatients and 23 therapists at two mental health clinics. Using the Bell Object Relations and Reality Testing Inventory, we measured 4 dimensions of patients' object relations at baseline-alienation, insecure attachment, egocentricity, and social incompetence. Using the Working Alliance Inventory, we measure alliance from patient and therapist perspectives. Control variables included time, patient demographics, symptom severity, and clinic. We employed hierarchical linear modeling to analyze data with a nested structure, with 138 sessions at level 1, 73 patients at level 2, and 23 therapists at level 3. Results. Patient alienation and insecure attachment were associated with lower patient-rated alliance, while egocentricity was associated with higher patient-rated alliance. Patients' object relations were not significantly associated with therapistrated alliance. On average, patients perceived the alliance more positively than their therapists, with a weak positive correlation between the alliance perspectives. Conclusions. The results suggest that object relation dimensions may be important patient characteristics for forecasting therapeutic relationship quality. They also call for more attention to differences between alliance rating perspectives.
Revista de Psicología, 2012
Journal of Consulting and Clinical Psychology, 2009
The present study examined the power of measures of early preschool behavior to predict later dia... more The present study examined the power of measures of early preschool behavior to predict later diagnoses of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD)/conduct disorder (CD). Participants were 168 children with behavior problems at age 3 who underwent a multi-method assessment of ADHD and ODD symptoms and were followed annually for 3 years. Fifty-eight percent of 3-year-old children with behavior problems met criteria for ADHD and/or ODD/CD 3 years later. Using a diagnostic interview and rating scales at age 3, later diagnostic status could be accurately predicted for three-quarters of children for ADHD and for two-thirds of children for ODD/CD. Predictive power of the best models did not increase significantly at age 4 and age 5 compared to age 3. Results provide support for the validity of early diagnoses of ADHD, though caution is needed in making diagnoses because a significant minority of children with early hyperactivity and inattention do outgrow their problems. Keywords ADHD; ODD; preschool-aged children; assessment Attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) are not typically diagnosed until school-age, but often emerge during the preschool years (Applegate et al., 1997). Prospective studies of community samples have documented that early behavior problems are linked to later difficulties (e.g., Moffitt, 1990), but only a small number of studies arising from six longitudinal data sets have addressed the frequency with which preschool-aged children (under age 5) with behavior problems later meet criteria for ADHD or ODD
Family Relations, 2012
This longitudinal study examined whether mothers' depressive symptomatology predicted parenting p... more This longitudinal study examined whether mothers' depressive symptomatology predicted parenting practices in a sample of 199 mothers of 3-year-old children with behavior problems who were assessed yearly until age 6. Higher maternal depressive symptoms were associated with higher overreactivity and laxness and lower warmth when children were 6 years old. Higher maternal depressive symptoms were also related to increases in overreactivity across the preschool years. Moreover, depression and parenting practices (overreactivity and laxness) covaried over time within mothers. These results provide evidence of a strong link between maternal depression and parenting during the preschool years.
Psykhe (Santiago), 2019
Este artículo presenta información relevante para profesionales de la salud mental que trabajarán... more Este artículo presenta información relevante para profesionales de la salud mental que trabajarán con pacientes adultos con trastorno por estrés post-traumático (TEPT) en las postrimerías de un desastre de origen natural y que no poseen entrenamiento especializado en modalidades expertas para el manejo de TEPT. El artículo presenta orientaciones a partir de una revisión de diferentes guías internacionales para el trabajo con pacientes con TEPT y la revisión de la literatura científica internacional relevante. Estas orientaciones fueron revisadas por un panel de expertos chilenos. El resultado, el cual se presenta en este artículo, es una serie de orientaciones prácticas orientadas a aquellos psicoterapeutas que trabajarán con pacientes con TEPT tras la ocurrencia de un desastre de origen natural. Se presentan viñetas clínicas para ejemplificar algunas de las orientaciones. Palabras clave: desastres de origen natural, estrés post-traumático, psicoterapia, orientaciones This article presents information relevant to mental health professionals who work with adult patients with posttraumatic stress disorder (PTSD) in the aftermath of natural disasters and who lack specialized training in evidencebased treatments for PTSD. The article presents orientations based on a review of several international guidelines for working with patients with PTSD and the relevant international scientific literature. These guidelines were reviewed by a panel of Chilean experts. The result, which is presented in this article, consists in a series of practical guidelines aimed at psychotherapists who must work with patients with PTSD after natural disasters. Clinical vignettes are presented to exemplify some of these guidelines.
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Papers by Paula Errázuriz