Reflexões acerca do potencial iatrogênico das psicoterapias no campo da Saúde Mental

Autores

  • Cláudio Kazuo Akimoto Júnior Instituto de Psicologia da Universidade de São Paulo
  • Maria Lívia Tourinho Moretto

DOI:

https://doi.org/10.57167/Rev-SBPH.19.412

Palavras-chave:

psicoterapia, iatrogenia, efeitos iatrogênicos, saúde mental

Resumo

Este trabalho apresenta pesquisa teórica sobre o tema do potencial iatrogênico das psicoterapias no campo da Saúde Mental, propondo uma reflexão sobre o problema que se coloca a partir dos achados. Desde a Grécia Antiga, com Hipócrates, estabeleceu-se como princípio basilar das práticas de cura que, primeiramente, não se deve causar mal ao paciente. Hoje sabe-se que qualquer tratamento com potencial para curar tem também potencial iatrogênico. As pesquisas indicam que tratamentos em saúde mental provocam piora do quadro clínico do paciente em até 10% dos casos. Contudo, neste campo, a pesquisa sobre o tema pouco avançou, enfrentando forte resistência por parte dos profissionais da área, que dão mais ênfase às pesquisas sobre os efeitos terapêuticos de suas práticas, apresentando pouca familiaridade com a questão das iatrogenias. Concluímos que, de acordo com o princípio hipocrático, é fundamental que psicoterapeutas e outros profissionais da área da Saúde, estejam atentos ao potencial iatrogênico de suas práticas, possibilitando, simultaneamente, uma fundamentação mais consistente com relação aos efeitos terapêuticos de seu trabalho. Espera-se que este trabalho sirva de base para ampliar a discussão sobre o potencial iatrogênico dos tratamentos em saúde mental, visando, em última instancia, a redução de danos decorrentes dos mesmos.

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Biografia do Autor

Cláudio Kazuo Akimoto Júnior, Instituto de Psicologia da Universidade de São Paulo

Advogado, Psicólogo e Psicanalista. Mestre em Psicologia Clínica pelo Instituto de Psicologia da Universidade de São Paulo. Membro do Laboratório de Psicanálise, Saúde e Instituição (LABPSI-USP).

Maria Lívia Tourinho Moretto

Doutora em Psicologia Clínica e Docente do Programa de Pós-Graduação em Psicologia Clínica do Instituto de Psicologia da Universidade de São Paulo.

Referências

Balint, M. (1957). The doctor, his patient and the illness. (2rd ed.). London: Pitman Medical. DOI: https://doi.org/10.1097/00000441-195711000-00018

Barlow, D. H. (2010). Negative effects from psychological treatments: a perspective. American Psychologist, 65(1), 13-20. DOI: https://doi.org/10.1037/a0015643

Barron, F. & Leary, T. (1955). Changes in psychoneurotic patients with and without psychotherapy. Journal of Consulting Psychology, 19(4), 239-245. DOI: https://doi.org/10.1037/h0044784

Bergin, A. E. & Lambert, M. J. (1978). The evaluation of therapeutic outcomes.In S. Garfield, & A. E. Bergin, Handbook of Psychotherapy and Behavior Change. New York: Wiley.

Bergin, A. E. (1966). Some implications of psychotherapy research for therapeutic practice. Journal of Abnormal Psychology, 71(4), 235-246. DOI: https://doi.org/10.1037/h0023577

Berk, M., & Parker, G. (2009). The Elephant on the Couch: Side-Effects of Psychotherapy. Australian and New Zealand Journal of Psychiatry, 43, 787794. DOI: https://doi.org/10.1080/00048670903107559

Beutler, L. E., Frank, M., Schieber, S. C., Calvert, S., & Gaines, J. (1984). Comparative effects of group psychotherapies in a shortterm inpatient setting: An experience with deterioration effects. Psychiatry, 44, 67–76 DOI: https://doi.org/10.1080/00332747.1984.11024227

Bittar, C. (1991). Responsabilidade Civil Médica, odontológica e hospitalar. São Paulo: Editora Saraiva.

Boisvert, C. M. & Faust, D. F. (2007). Practicing psychologists’ knowledge of general psychotherapy research findings: Implications for science-practice relations. Professional Psychology: Research and Practice, 37(6), 708-716. DOI: https://doi.org/10.1037/0735-7028.37.6.708

Carkhuff, R. & Truax, C. (1964). For better or for worse: The process of psychotherapeutic change. In Recent advances in behavioral change. Montreal: McGill University Press.

Cartwright, D. S. (1956). Note on "changes" in psychoneurotic patients with and without psychotherapy. Journal of Consulting Psychology, 20(5), 403-404. DOI: https://doi.org/10.1037/h0044909

Cartwright, R. D., & Vogel, J. L. (1960). A comparison of changes in psychoneurotic patients during matched periods of therapy and no-therapy. Journal of Consulting Psychology, 24(2), 121-127. DOI: https://doi.org/10.1037/h0043823

Castonguay, L; Boswell, J; Constantino, M; Goldfried, M; & Hill, C. (2010). Training Implications of Harmful Effects of Psychological Treatments. American Psychologist, 65(1), 34-49. DOI: https://doi.org/10.1037/a0017330

Centro de Perícias Médicas e Saúde Ocupacional do Corpo de Bombeiros Militar do Estado do Rio de Janeiro (1999). Artigos: Iatrogenia. Recuperado em 26 de abril, 2016, do Website da CPMSO: http://www.cpmso.cbmerj.rj.gov.br/modules.php?name=Content&file=print&pid=121

Crown, S. (1983). Contraindications and dangers of psychotherapy. The British Journal of Psychiatry, 143, 436-441. DOI: https://doi.org/10.1192/bjp.143.5.436

Dimidjian, S, & Hollon, S. (2010). How would we know if psychotherapy were harmful? American Psychologist, 65, 21-33. DOI: https://doi.org/10.1037/a0017299

Doherty, W. J., Lester, M. E., & Leigh, G. K. (1986). Marriage encounter weekends: Couples who win and couples who lose. Journal of Marital and Family Therapy, 12, 49-61. DOI: https://doi.org/10.1111/j.1752-0606.1986.tb00638.x

Eaton, T. T., Abeles, N., Gutfreund, M. J. (1993). Negative indicators, therapeutic alliance, and therapy outcome. Psychotherapy Research, 3, 115-123. DOI: https://doi.org/10.1080/10503309312331333719

Emmelkamp, P. M. G., de Haan, E., & Hoogduin, C. A. L. (1990). Marital adjustment and obsessive-compulsive disorder. British Journal of Psychiatry, 156, 55-60. DOI: https://doi.org/10.1192/bjp.156.1.55

Eysenck, H. J. (1952). The effects of Psychotherapy: an evaluation. Journal of Consulting Psychology, 16, 319. DOI: https://doi.org/10.1037/h0063633

Fairweather, G. W., Simon, R., Gebhard, M. E., Weingarten, E., Holland, J. L., Sanders, R., Stone, G. B., Reahl, J. E. (1960). Relative effectiveness of psychotherapeutic programs: a multicriteria comparison of four programs for three different patient groups. Psychological Monographs: General and Applied, 74(5), 1-26. DOI: https://doi.org/10.1037/h0093756

Ferreira, A. (1985). Pequeno Dicionário Brasileiro da Língua Portuguesa. Rio de Janeiro: Editora Nacional.

Foa, E. B., & Emmkelkamp, P. M. (1983). Failures in behavioural therapy. New York: John Wiley and Sons.

Freud, S. (1913/1996). Sobre o início do tratamento. In S. Freud, Edição Standard Brasileira das Obras Psicológicas Completas de Sigmund Freud (Vol.XII). Rio de Janeiro: Editora Imago

Grammaticos, P. C., & Diamantis, A. (2008). Useful known and unknown views of the father of modern medicine, Hippocrates and his teacher Democritus. Hellenic Journal of Nuclear Medicine, 11(1), 2-4.

Hadley, S. W., & Strupp, H. H. (1976). Contemporary views of negative effects in psychotherapy: an integrated account. Archives of General Psychiatry, DOI: https://doi.org/10.1001/archpsyc.1976.01770110019001

(11), 1291-1302Hans, H., Strupp, H., Suzanne, W., Hadley, B., & Gomes-Schwartz, B. (1977). Psychotherapy for better or worse: the problem of negative effects. Califórnia: Editora J. Aronson.

Hansen, N. B., Lambert, M. J., & Forman, E. M. (2002). The psychotherapy dose-response effect and its implications for treatment delivery services. DOI: https://doi.org/10.1093/clipsy.9.3.329

Clinical Psychology: Science and Practice, 9, 329-343.

Henry, W. P., & Strupp, H. H. (1994). The therapeutic alliance as interpersonal process. In A. O. Horvath, & L. S. Greenberg (Eds.), The working alliance:

Theory, research, and practice (pp. 51-84). New York: Wiley.

Henry, W. P., Schacht, T. E., & Strupp, H. H. (1986). Structural analysis of social behavior: Application to a study of interpersonal process indifferential psychotherapeutic outcome. Journal of Consulting and Clinical Psychology, 54, 27-31. DOI: https://doi.org/10.1037//0022-006X.54.1.27

Jarrett, C. (2008). When Therapy Causes Harm. The Psychologist, 21(1), 10-12.

Jones, W. (1868/2006). Hippocrates Collected Works I. Cambridge: Harvard. University Press, retrieved September 28.

Lambert, M. & Ogles, B. (2004). The efficacy and effectiveness of psychotherapy. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed., pp. 169-218). New York: Wiley.

Lambert, M., Bergin, A, & Collins, J. (1977). Therapist-induced deterioration in psychotherapy. In A. S. Gurman, & A. M. Razin (Eds.), Effective psychotherapy: A handbook of research. Oxford, England: Pergamon Press.

Lazarou, J., Pomeraz, B., & Corey, P. (1998). Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. The Journal of the American Medical Association, 279(15), 1200-1205. DOI: https://doi.org/10.1001/jama.279.15.1200

Leapel, L. (1992). Unnecessary Surgery. Health Services Research, 24(3), 351-407.

Levenson, J. C., Frank, E., Cheng, Y., Rucci, P., Janney, C. A., Houck, P., Forgione, R. N., Swartz, H. A., Cyranowski, J. M., & Fagiolini, A. (2010). Comparative outcomes among the problem areas of interpersonal psychotherapy for depression. Depression and Anxiety, 27(5), 434–440. DOI: https://doi.org/10.1002/da.20661

Lilienfield, S. (2007). Psychological Treatments That Cause Harm. Perspectiveson Psychological Science, 2(1). DOI: https://doi.org/10.1111/j.1745-6916.2007.00029.x

Linden, M. (2012). How to Define, Find and Classify Side Effects in Psychotherapy: From Unwanted Events to Adverse Treatment Reactions. Clinical Psychology & Psychotherapy, 20(3), 286-296. DOI: https://doi.org/10.1002/cpp.1765

Luborsky, L., Singer, B., & Luborsky, L. (1975). Comparative studies in psychotherapy: a review of quantitative research. Archives of General Psychiatry, 32, 995-1008. DOI: https://doi.org/10.1001/archpsyc.1975.01760260059004

Mays, D., & Franks, C. (Eds.). (1985). Negative outcome in psychotherapy and what to do about it. New York: Springer.

Mink, O. (1959). A comparison of effectiveness of nondirective therapy and clinical counseling in the junior high school. School Counselor.

Mohr, D. (1995). Negative outcome in psychotherapy: A critical review. Clinical Psychology: Science and Practice, 2(1), 1-27. DOI: https://doi.org/10.1111/j.1468-2850.1995.tb00022.x

Moos, R. (2005). Iatrogenic effects of psychosocial interventions for substance use disorders: prevalence, predictors, prevention. Addiction, 100(5), 595-604. DOI: https://doi.org/10.1111/j.1360-0443.2005.01073.x

Nutt, D. & Sharpe, M. (2008). Uncritical positive regard? Issues in the efficacy and safety of psychotherapy. Journal of Psychopharmacology, 22, 3. DOI: https://doi.org/10.1177/0269881107086283

Padilha, K. (2001). Considerações sobre as ocorrências iatrogênicas na assistência à saúde: dificuldades inerentes ao estudo do tema. Revista da Escola de Enfermagem da USP, 35(3), 287-90. DOI: https://doi.org/10.1590/S0080-62342001000300013

Phillip, D., Christenfeld, N., & Glynn, L. (1998). Increase in US medication-error deaths between 1983 and 1993. Lancet, 351, 643-644. DOI: https://doi.org/10.1016/S0140-6736(98)24009-8

Powers, E., & Witmer, H. (1951). An experiment in the prevention of delinquency. New York: Columbia University Press.

Rogers, C. R. & Dymond, R. F. (1954). Psychotherapy and personality change. Chicago: University of Chicago Press.

Rogers, C. R. (1961). A theory of psychotherapy with schizophrenics and a proposal for its empirical investigation. In J. G. Dawson, & N. P. Dellis (Eds.),

Psychotherapy with schizophrenics. Baton Rouge: Louisiana State University Press.

Smith, M., Glass, G., & Miller, T. (1980). The benefits of psychotherapy. Baltimore: Johns Hopkins University Press.

Starfield, B. (2000). Is US Health Really the Best in the World? Journal of the American Medical Association, 284(4), 483-485. DOI: https://doi.org/10.1001/jama.284.4.483

Steel, K., Gertman, P., Crescenzi, C., & Anderson, J. (1981). Iatrogenic illness on a general medical service at a university hospital. Quality and Safety in Health Care, 13(1), 76-80. DOI: https://doi.org/10.1136/qshc.2002.003830

Tavares, F. M. (2007). Reflexões acerca da iatrogenia e educação médica. Revista Brasileira de Educação Médica, 31(2), 180-185 DOI: https://doi.org/10.1590/S0100-55022007000200010

Truax, C. (1963). Effective ingredients in psychotherapy. Journal of Counsulting Clinical Psychology, 46(5), 1023-1035.

Warren, J., Nelsom, P., Mondragons, S., Baldwin, S., Burlingam, G. (2010). Youth psychotherapy change trajectories and outcomes in usual care: Community mental health versus managed care settings. Journal of Consulting and Clinical Psychology, 78(2), 144-55. DOI: https://doi.org/10.1037/a0018544

WEBSTER (1993). Third new international dictionary. Springfield, MA: MerriammWebster. Disponível em: http://www.merriam-webster.com/dictionary/

Weiss, B., Catron, T., Harris, V., & Phung, T. (1999). The effectiveness of traditional child psychotherapy. Journal of Consulting and Clinical Psychology, 67(1), 82-94. DOI: https://doi.org/10.1037//0022-006X.67.1.82

Weisz, J., Donenberg, G., Han, S., & Launeckis, D. (1995). Child and adolescent psychotherapy outcomes in experiments and in clinics: Why the disparity? Journal of Abnormal Child Psychology, 23(1), 83-106 DOI: https://doi.org/10.1007/BF01447046

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Publicado

23-01-2016

Como Citar

Akimoto Júnior, C. K., & Moretto, M. L. T. (2016). Reflexões acerca do potencial iatrogênico das psicoterapias no campo da Saúde Mental. Revista Da Sociedade Brasileira De Psicologia Hospitalar, 19(1), 76–102. https://doi.org/10.57167/Rev-SBPH.19.412

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