Terapia integrativa para el abordaje de los problemas de pareja: informe de un caso clínico
Integrative therapy for addressing couple relationship problems: a clinical case reportBarra lateral del artículo
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Introducción: Se presenta un informe de caso sobre la intervención psicológica de una pareja ecuatoriana con problemas en la relación conyugal asociados con dificultades en la crianza de los hijos, problemas económicos, resentimiento, conductas hostiles e insatisfacción con las expresiones afectivas. Objetivo: Mejorar la interacción y la calidad del vínculo afectivo. Método: Se empleó un enfoque integrativo basado en la terapia de pareja cognitivo-conductual, la terapia de aceptación y compromiso y la psicoterapia gestáltica, que constó de ocho sesiones semanales y dos de seguimiento. La evaluación incluyó entrevistas semiestructuradas, observación e instrumentos psicológicos. Resultados: Se observaron cambios favorables en la regulación emocional, la expresión afectiva, el funcionamiento familiar y la satisfacción conyugal, que se mantuvieron parcialmente en el seguimiento, aunque surgieron nuevas dificultades relacionales. Conclusión: El caso es relevante porque muestra la adaptación e integración de estrategias de distintas terapias según las necesidades de la pareja, además de permitir identificar cambios y desafíos posteriores a la intervención.
Introduction: This case report describes the psychological intervention provided to an Ecuadorian couple experiencing marital relationship difficulties associated with challenges in child-rearing, financial problems, resentment, hostile behaviors, and dissatisfaction with expressions of affection. Objective: To improve interaction and the quality of the emotional bond. Method: An integrative approach was employed, drawing on cognitive-behavioral couples therapy, acceptance and commitment therapy, and Gestalt psychotherapy. The intervention consisted of eight weekly sessions and two follow-up sessions. The assessment included semi-structured interviews, observation, and psychological assessment instruments. Results: Favorable changes were observed in emotional regulation, expressions of affection, family functioning, and marital satisfaction. These changes were partially maintained at follow-up, although new relational difficulties emerged. Conclusion: This case is relevant because it illustrates how strategies from different therapeutic approaches can be adapted and integrated according to the couple's needs, while also allowing changes and challenges arising after the intervention to be identified.
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Adl, H.-S., Pirani, Z., & Abbasi, M. (2024). Comparison of the effectiveness of enhanced cognitive-behavioral couple therapy on emotional self-regulation and couple burnout of self-assigned and court-referred incompatible couples. Journal of Marital and Family Therapy, 50(4), 785–800. https://doi.org/10.1111/jmft.12722
Asociación Americana de Psiquiatría. (2014). Manual diagnóstico y estadístico de los trastornos mentales (DSM-5) (5.ª ed.). Editorial Médica Panamericana.
Baucom, D. H., & Epstein, N. (1990). Cognitive-behavioral marital therapy. Brunner/Mazel. https://archive.org/details/cognitivebehavio0000bauc
Berge, S. D., Meland, E., Brekke, M., Bondevik, G. T., Thuen, F., & Mildestvedt, T. (2021). Couple relationship problems—a task for the general practitioner? A cross-sectional survey from Norway. Family Practice, 38(2), 115–120. https://doi.org/10.1093/fampra/cmaa093
Cano-Prous, A., Martín-Lanas, R., Moyá-Querejeta, J., Beunza-Nuin, M., Lahortiga-Ramos, F., & García-Granero, M. (2014). Psychometric properties of a Spanish version of the Dyadic Adjustment Scale. International Journal of Clinical and Health Psychology, 14(2), 137–144. https://dialnet.unirioja.es/servlet/articulo?codigo=4678272
Carrasco, M. J. (1998). ASPA. Cuestionario de aserción en la pareja: Manual (2.ª ed. rev. y ampl.). TEA Ediciones. https://dialnet.unirioja.es/servlet/libro?codigo=25112
Christensen, A., & Doss, B. D. (2017). Integrative behavioral couple therapy. Current Opinion in Psychology, 13, 111–114. https://doi.org/10.1016/j.copsyc.2016.04.022
Christensen, A., Atkins, D. C., Berns, S., Wheeler, J., Baucom, D. H., & Simpson, L. E. (2004). Traditional versus integrative behavioral couple therapy for significantly and chronically distressed married couples. Journal of Consulting and Clinical Psychology, 72(2), 176–191. https://doi.org/10.1037/0022-006X.72.2.176
Christensen, A., Atkins, D. C., Yi, J., Baucom, D. H., & George, W. H. (2006). Couple and individual adjustment for 2 years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy. Journal of Consulting and Clinical Psychology, 74(6), 1180–1191. https://doi.org/10.1037/0022-006X.74.6.1180
Côté, M., Tremblay, J., & Dufour, M. (2022). What is known about the forgiveness process and couple therapy in adults having experienced serious relational transgression? A scoping review. Journal of Couple & Relationship Therapy, 21(3), 207–232. https://doi.org/10.1080/15332691.2021.1939216
Doss, B. D., Rhoades, G. K., Stanley, S. M., & Markman, H. J. (2009). The effect of the transition to parenthood on relationship quality: An 8-year prospective study. Journal of Personality and Social Psychology, 96(3), 601–619. https://doi.org/10.1037/a0013969
Doss, B. D., Roddy, M. K., Wiebe, S. A., & Johnson, S. M. (2022). A review of the research during 2010–2019 on evidence-based treatments for couple relationship distress. Journal of Marital and Family Therapy, 48(1), 283–306. https://doi.org/10.1111/jmft.12552
Eidelson, R. J., & Epstein, N. (1982). Cognition and relationship maladjustment: Development of a measure of dysfunctional relationship beliefs. Journal of Consulting and Clinical Psychology, 50(5), 715–720. https://doi.org/10.1037/0022-006X.50.5.715
Ellis, A. (1962). Reason and emotion in psychotherapy. Lyle Stuart. https://archive.org/details/reasonemotioninp00elli
Epstein, N. B., & Zheng, L. (2017). Cognitive-behavioral couple therapy. Current Opinion in Psychology, 13, 142–147. https://doi.org/10.1016/j.copsyc.2016.09.004
Fehr, R., Gelfand, M. J., & Nag, M. (2010). The road to forgiveness: A meta-analytic synthesis of its situational and dispositional correlates. Psychological Bulletin, 136(5), 894–914. https://doi.org/10.1037/a0019993
First, M. B. (2017). DSM-5: Manual de diagnóstico diferencial. Editorial Médica Panamericana. https://www.medicapanamericana.com/es-BR/libros/dsm-5-manual-de-diagnostico-diferencial-dsm-5r?srsltid=AfmBOoqfPDspew9lutPaMoCwyo1UqNuOk_e0kuuZNIC3PsaOwiTy42FW
Gottman, J. M. (1998). Psychology and the study of marital processes. Annual Review of Psychology, 49, 169–197. https://doi.org/10.1146/annurev.psych.49.1.169
Harris, E. S. (2007). Working with forgiveness in Gestalt therapy. Gestalt Review, 11(2), 108–119. https://doi.org/10.5325/gestaltreview.11.2.0108
Hayes, S. C. (1984). Making sense of spirituality. Behaviorism, 12, 99–110. https://philpapers.org/rec/HAYMSO-2
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. Guilford Press. https://contextualscience.org/publications/hayes_strosahl_wilson_1999
Labrador, F. J. (Coord.). (2015). Intervención psicológica en terapia de pareja: Evaluación y tratamiento. Pirámide. https://www.edicionespiramide.es/libro/manuales-practicos/intervencion-psicologica-en-terapia-de-pareja-francisco-javier-labrador-encinas-9788436833607/
Lavner, J. A., & Bradbury, T. N. (2010). Patterns of change in marital satisfaction over the newlywed years. Journal of Marriage and Family, 72(5), 1171–1187. https://doi.org/10.1111/j.1741-3737.2010.00757.x
Lev, A., & McKay, M. (2018). Terapia de aceptación y compromiso para parejas: Guía clínica para utilizar mindfulness, valores y consciencia de los esquemas mentales para reconstruir las relaciones. Desclée de Brouwer. https://www.abebooks.com/9788433030160/Terapia-Aceptaci%C3%B3n-Compromiso-parejas-Gu%C3%ADa-8433030167/plp
McNulty, J. K., Meltzer, A. L., Neff, L. A., & Karney, B. R. (2021). How both partners' individual differences, stress, and behavior predict change in relationship satisfaction: Extending the VSA model. Proceedings of the National Academy of Sciences, 118(27), e2101402118. https://doi.org/10.1073/pnas.2101402118
Monestès, J. L., & Hayes, S. C. (2022). Evolutionary principles in psychotherapy: An integrative framework for clinical practice. In G. Asmundson (Ed.), Comprehensive clinical psychology (2nd ed., Vol. 1, pp. 225–241). Elsevier. https://doi.org/10.1016/B978-0-12-818697-8.00079-0
Norcross, J. C., & Goldfried, M. R. (Eds.). (2005). Handbook of psychotherapy integration (2.ª ed.). Oxford University Press. https://global.oup.com/academic/product/handbook-of-psychotherapy-integration-9780190690465?cc=cu&lang=en&
Organización Mundial de la Salud. (2020). Clasificación internacional de enfermedades (11.ª revisión). https://icd.who.int/
Overall, N. C., & McNulty, J. K. (2017). What type of communication during conflict is beneficial for intimate relationships? Current Opinion in Psychology, 13, 1–5. https://doi.org/10.1016/j.copsyc.2016.03.002
Pérez, A., Rubio, V., & Gómez, M. (2007). Cuestionario Salamanca (versión 2007) para el screening de trastornos de la personalidad. Sociedad Española para el Estudio de los Trastornos de la Personalidad. https://enmente.clinic/test-autoaplicados/test/salamanca-personalidad/
Perls, F., Hefferline, R., & Goodman, P. (1951). Terapia gestalt: Excitación y crecimiento de la personalidad humana. Sociedad de Cultura Valle-Inclán. https://gestaltnet.net/gestaltoteca/libros/monografias/terapia-gestalt-excitacion-crecimiento-personalidad-humana
Peterson, B. D., Eifert, G. H., Feingold, T., & Davidson, S. (2009). Using acceptance and commitment therapy to treat distressed couples: A case study with two couples. Cognitive and Behavioral Practice, 16(4), 430–442. https://doi.org/10.1016/j.cbpra.2008.12.009
Pietromonaco, P. R., & Overall, N. C. (2021). Applying relationship science to evaluate how the COVID-19 pandemic may impact couples' relationships. American Psychologist, 76(3), 438–450. https://doi.org/10.1037/amp0000714
Proulx, C. M., Helms, H. M., & Buehler, C. (2007). Marital quality and personal well-being: A meta-analysis. Journal of Marriage and Family, 69(3), 576–593. https://doi.org/10.1111/j.1741-3737.2007.00393.x
Robles, T. F., Slatcher, R. B., Trombello, J. M., & McGinn, M. M. (2014). Marital quality and health: A meta-analytic review. Psychological Bulletin, 140(1), 140–187. https://doi.org/10.1037/a0031859
Rothman, K., Cicila, L. N., McGinn, M., Hatch, S. G., Christensen, A., & Doss, B. D. (2021). Trajectories of sexual satisfaction and frequency during and after couple therapy for relationship distress. Journal of Sex & Marital Therapy, 47(3), 209–223. https://doi.org/10.1080/0092623X.2020.1850575
Taggart, T. C., Bannon, S. M., & Hammett, J. F. (2019). Personality traits moderate the association between conflict resolution and subsequent relationship satisfaction in dating couples. Personality and Individual Differences, 139, 281–289. https://doi.org/10.1016/j.paid.2018.11.036
Topkaya, N., Şahin, E., & Mehel, F. (2023). Relationship-specific irrational beliefs and relationship satisfaction in intimate relationships. Current Psychology, 42(2), 1257–1269. https://doi.org/10.1007/s12144-021-01426-y
Twenge, J. M., Campbell, W. K., & Foster, C. A. (2003). Parenthood and marital satisfaction: A meta-analytic review. Journal of Marriage and Family, 65(3), 574–583. https://doi.org/10.1111/j.1741-3737.2003.00574.x
Villavicencio, C., & Jaramillo, J. (2020). Desgaste emocional en la convivencia afectiva de pareja. Revista de Investigación en Ciencias Sociales y Humanidades, 7(1), 58–66. https://doi.org/10.30545/academo.2020.ene-jun.6
Waddell, N., Overall, N. C., Chang, V. T., & Hammond, M. D. (2021). Gendered division of labor during a nationwide COVID-19 lockdown: Implications for relationship problems and satisfaction. Journal of Social and Personal Relationships, 38(6), 1759–1781. https://doi.org/10.1177/0265407521996476
Whisman, M. A., & Baucom, D. H. (2012). Intimate relationships and psychopathology. Clinical Child and Family Psychology Review, 15(1), 4–13. https://doi.org/10.1007/s10567-011-0107-2
Wilson, K. G., & Luciano, M. C. (2002). Terapia de aceptación y compromiso (ACT): Un tratamiento conductual orientado a los valores. Pirámide. https://www.edicionespiramide.es/libro/psicologia/terapia-de-aceptacion-y-compromiso-act-kelly-g-wilson-9788436817195/
Wood, N. D., Crane, D. R., Schaalje, G. B., & Law, D. D. (2005). What works for whom: A meta-analytic review of marital and couples therapy in reference to marital distress. American Journal of Family Therapy, 33(4), 273–287. https://doi.org/10.1080/01926180590962147
Zinker, J. C. (1994). In search of good form: Gestalt therapy with couples and families. Jossey-Bass. https://www.routledge.com/In-Search-of-Good-Form-Gestalt-Therapy-with-Couples-and-Families/Zinker/p/book/9780881632934