Affirmative psychological services for LGTBIQA+ persons in Ecuador
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Keywords

diversidades sexo genéricas
evidencia basada en la práctica
CORE-OM
terapia afirmativa
estrés de minorías sexual and gender diversity
practice-based evidence
CORE-OM
affirmative therapy
minority stress

How to Cite

Zúñiga-Salazar, E., Valdiviezo-Oña, J., Ruiz-Cordoba, O., Baldus-Andrade, D., & Paz, C. (2022). Affirmative psychological services for LGTBIQA+ persons in Ecuador: changes in psychological distress. Terapia Psicológica, 39(3), 353-374. https://doi.org/10.4067/S0718-48082021000300353

Abstract

Background: Although in the Anglo-Saxon world Affirmative Therapy has a long history with strong empirical support, in Ibero-America its development is recent. Objective: To analyze the Practice-Based Evidence of a network of affirmative psychology services for LGTBIQA+ persons in Ecuador. Methods: This is a naturalistic study analyzing Practice-Based Evidence generated using the Clinical Outcomes in Routine Evaluation - Outcome Measure as a routine evaluation tool to monitor the outcomes of 101 clients who received Affirmative Therapy between 2018 and 2020 in a network of affirmative psychology services for LGTBIQA+ people. Statistically significant change and reliable, clinically meaningful change were assessed. Results: Participants were on average 27.14 years old. The median number of sessions was six. There were statistically significant changes for those who completed the questionnaire at least twice. A large effect size was found for the total score and all dimensions except for Risk. Sixty-eigth percent participants showed improvement. Conclusions: The results suggest that Affirmative Therapy minimizes the risk brought on by minority stress. Students, therapists, and clients are encouraged to learn, adopt, and use Affirmative Therapy, respectively.

https://doi.org/10.4067/S0718-48082021000300353
PDF (Español (España))

References

Andrinopoulos, K., & Hembling, J. (2014). Homonegatividad Internalizada y sus Consecuencias Relacionadas con la Salud para los HSH en San Salvador. MEASURE Evaluation. https://tinyurl.com/2p95eaba

António, R., & Moleiro, C. (2015). Social and parental support as moderators of the effects of homophobic bullying on psychological distress in youth. Psychology in the Schools, 52(8), 729–742. https://doi.org/10.1002/pits.21856

António, R., Pinto, T., Pereira, C., Farcas, D., & Moleiro, C. (2012). Bullying homofóbico no contexto escolar em Portugal. Psicologia, 26(1), 17–32. https://doi.org/10.17575/rpsicol.v26i1.260

Ardila, R. (2007). Terapia afirmativa para homosexuales y lesbianas. Revista Colombiana de Psiquiatría, 36(1), 67–77. https://tinyurl.com/bden6fdt

Astaíza, A. (2016). Situación actual de los tratamientos psicológicos para la homosexualidad. Revista de Psicología Universidad de Antioquía, 8(2), 173–194. https://tinyurl.com/5n8xru3w

Bados, A., & García, E. (2011). Habilidades terapéuticas. Universitat de Barcelona.

Barkham, M., Hardy, G. E., & Mellor-Clark, J. (Eds.). (2010). Developing and Delivering Practice-Based Evidence: A Guide for the Psychological Therapies. John Wiley & Sons. https://doi.org/10.1002/9780470687994

Barrientos, J., Espinoza-Tapia, R., Meza Opazo, P., Saiz, J. L., Cárdenas Castro, M., Guzmán-González, M., Gómez Ojeda, F., Bahamondes Correa, J., & Lovera Saavedra, L. (2019). Efectos del prejuicio sexual en la salud mental de personas transgénero chilenas desde el Modelo de Estrés de las Minorías: Una aproximación cualitativa. Terapia psicológica, 37(3), 181–197. https://doi.org/10.4067/S0718-48082019000300181

Borges, K. (2013). Terapia afirmativa: Uma introdução à psicologia e à psicoterapia dirigida a lésbicas e bissexuais. GLS.

Brandelli, A., Paveltchuk, F., Lawrenz, P., Vilanova, F., Juliane, Figueiredo, B., Habigzang, L. F., Caetano, H., & Dunn, T. (2020). Protocolo para Avaliar o Estresse de Minoria em Lésbicas, Gays e Bissexuais. Psico-USF, 25(2), 207–222. https://doi.org/hcgt

Brizuela, A., Brenes, M. P., Villegas, M., & Zúñiga, B. (2010). El abordaje teórico y clínico de la orientación sexual en Psicología. Wimb Lu, 5(1), 9–35. https://tinyurl.com/mswndkkk

Cáceres, C. F., Pecheny, M., Frasca, T., Rios, R. R., & Pocahy, F. (2008). Review of Legal Frameworks and the Situation of Human Rights related to Sexual Diversity in Low and Middle Income Countries. UNAIDS. https://tinyurl.com/4bv7s9t2

Comisión Internacional de Juristas. (2007). Principios de Yogyakarta. https://tinyurl.com/bdz6ef7e

Dohrenwend, B. P. (2000). The Role of Adversity and Stress in Psychopathology: Some Evidence and Its Implications for Theory and Research. Journal of Health and Social Behavior, 41(1), 1–19. https://doi.org/10.2307/2676357

Evans, C. (2021). CECPfuns: Package of Utility Functions for Psychological Therapies, Mental Health and Well-being work (Created by Chris Evans and Clara Paz). R package version 0.0.0.9041. https://github.com/cpsyctc/CECPfuns

Evans, C., Connell, J., Barkham, M., Margison, F., McGrath, G., Mellor-Clark, J., & Audin, K. (2002). Towards a standardised brief outcome measure: Psychometric properties and utility of the CORE–OM. British Journal of Psychiatry, 180(01), 51–60. https://doi.org/10.1192/bjp.180.1.51

Evans, C., Connell, J., Barkham, M., Marshall, C., & Mellor-Clark, J. (2003). Practice-based evidence: Benchmarking NHS primary care counselling services at national and local levels. Clinical Psychology & Psychotherapy, 10(6), 374–388. https://doi.org/10.1002/cpp.384

Evans, C., Margison, F., & Barkham, M. (1998). The contribution of reliable and clinically significant change methods to evidence-based mental health. Evidence-Based Mental Health, 1(3), 70–72. https://doi.org/10.1136/ebmh.1.3.70

Evans, C., Mellor-Clark, J., Margison, F., Barkham, M., Conell, J., & McGrath, G. (2000). CORE: Clinical Outcomes in Routine Evaluation. Journal of Mental Health, 9(3), 247–255. https://doi.org/10.1080/jmh.9.3.247.255

Feixas, G., Evans, C., Trujillo, A., Ãngel, L., Botella, L., Corbella, S., González, E., Bados, A., Garcia-Grau, E., & López-Gonzalez, M. A. (2012). La versión española del CORE-om: Clinical Outcomes in Routine Evaluation—Outcome Measure. Revista de Psicoterapia, 23(89), 109–135. https://doi.org/10.33898/rdp.v23i89.641

Herek, G. M. (2004). Beyond “Homophobiaâ€: Thinking about sexual prejudice and stigma in the twenty-first century. Sexuality Research and Social Policy, 1(2), 6–24. https://doi.org/bs9d7g

Hernández-Calderón, K. A., & Lesmes-Silva, A. K. (2018). La escucha activa como elemento necesario para el diálogo. Revista convicciones, 9(1), 83–87. https://tinyurl.com/bdd78d56

Jacobson, N., Follete, W., & Revenstorf, D. (1984). Psychotherapy outcome research: Methods for reporting variability and evaluating clinical significance. Behavior Therapy, 15(4), 336–352. https://doi.org/10.1016/S0005-7894(84)80002-7

Jacobson, N., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19. https://doi.org/10.1037/0022-006X.59.1.12

Kort, J. (2008). Gay affirmative therapy for the straight clinician: The essential guide. W. W. Norton & Company. https://tinyurl.com/3hfbtam9

Kruijt, A.-W. (2021). JTRCI: obtain and plot Jacobson-Truax and reliable change indices. R package version 0.1.0. https://rdrr.io/github/AWKruijt/JT-RCI/

López, A. (2019). Elementos del encuadre terapéutico para la creación del vínculo entre paciente y terapeuta en el abordaje plurimodal en musicoterapia (APM). Revista Brasileira de Musicoterapia, 21(26), 84–105. https://tinyurl.com/4ar6em53

López, P., Forrisi, F., & Gelpi, G. (Eds.). (2015). Salud y diversidad sexual: Guía para profesionales de la salud. UNFPA. https://tinyurl.com/bjpf2k4m

Lorenzi, G., Miscioscia, M., Ronconi, L., Pasquali, C., & Simonelli, A. (2015). Internalized Stigma and Psychological Well-Being in Gay Men and Lesbians in Italy and Belgium. Social Sciences, 4(4), 1229–1242. https://doi.org/10.3390/socsci4041229

Lyne, K. J., Barrett, P., Evans, C., & Barkham, M. (2006). Dimensions of variation on the CORE-OM. British Journal of Clinical Psychology, 45(2), 185–203. https://doi.org/bckz77

Martin, A. D., & Hetrick, E. S. (1988). The Stigmatization of the Gay and Lesbian Adolescent. Journal of Homosexuality, 15(1–2), 163–183. https://doi.org/10.1300/J082v15n01_12

Martín, G. J. (2016). Quiérete mucho, maricón: Manual de éxito psicoemocional para hombres homosexuales. Roca Editorial. https://tinyurl.com/4arnmrxz

Martínez, C., Tomicic, A., Rosenbaum, C., Gálvez, C., Rodríguez, J., & Aguayo, F. (2018). Psicoterapia culturalmente competente para el trabajo con pacientes LGBT+: Una guía para psicoterapeutas y profesionales de la salud mental. Centro de Estudios en Psicología Clínica & Psicoterapia, Universidad Diego Portales (CEPPS-UDP). https://tinyurl.com/yckpx9mh

da Mata, L. R., Bernardes, M. F., Azevedo, C., Chianca, T. C., Pereira, M., & de Carvalho, E. (2018). Jacobson and Truax Method: Evaluation of the clinical effectiveness of a home care program after prostatectomy. Revista latino-americana de enfermagem, 26, 1–8. https://doi.org/10.1590/1518-8345.2249.3003

Mayfield, W. (2001). The Development of an Internalized Homonegativity Inventory for Gay Men. Journal of Homosexuality, 41(2), 53–76. https://doi.org/10.1300/J082v41n02_04

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674

Ministerio de Salud Pública del Ecuador. (2016). Atención en salud a personas lesbianas, gays, bisexuales, transgénero e intersex (LGBTI). Manual. Dirección Nacional de Normatización, Dirección Nacional de Derechos Humanos Género e Inclusión-MSP. https://tinyurl.com/4ct4jjxn

Morga, L. E. (2012). Teoría y técnica de la entrevista. Red Tercer Milenio. https://tinyurl.com/2p8p7end

Muñoz-León, F. (2016). Cisnormatividad y transnormatividad como ideologías que articulan el tratamiento jurídico de la condición trans. Revista Austral de Ciencias Sociales, 30, 161–181. https://doi.org/10.4206/rev.austral.cienc.soc.2016.n30-08

Mütze, K., Witthöft, M., & Bräscher, A.-K. (2020). Prediction of Therapeutic Outcome in a Naturalistic Setting Using Pretreatment Psychological Distress Indicators. Verhaltenstherapie, 1–9. https://doi.org/10.1159/000510272

Ortíz, D. (2014). Bases para la construcción de una psicología sistémica. Sophía, 16(1), 84–98. https://doi.org/10.17163/soph.n16.2014.04

O’Shaughnessy, T., & Speir, Z. (2018). The state of LGBQ affirmative therapy clinical research: A mixed-methods systematic synthesis. Psychology of Sexual Orientation and Gender Diversity, 5(1), 82–98. https://doi.org/10.1037/sgd0000259

Pachankis, J. E., Hatzenbuehler, M. L., Rendina, H. J., Safren, S. A., & Parsons, J. T. (2015). LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: A randomized controlled trial of a transdiagnostic minority stress approach. Journal of Consulting and Clinical Psychology, 83(5), 875–889. https://doi.org/10.1037/ccp0000037

Paveltchuk, F., & Callegaro, J. (2020). A teoria do estresse de minoria em lésbicas, gays e bissexuais. Revista da SPAGESP, 21(2), 41–54. https://tinyurl.com/bp528de2

Paveltchuk, F., Callegaro, J., & Figueiredo, B. (2020). Apoio Social, Resiliência, Estresse de Minorias e Saúde Mental de Mulheres Lésbicas e Bissexuais. Psico-USF, 25(3), 403–414. https://doi.org/10.1590/1413-82712020250301

Paz, C., Mascialino, G., & Evans, C. (2020). Exploration of the psychometric properties of the Clinical Outcomes in Routine Evaluation-Outcome Measure in Ecuador. BMC Psychology. https://doi.org/10.1186/s40359-020-00443-z

Perpiñá, C. (Ed.). (2012). Manual de la entrevista psicológica: Saber escuchar, saber preguntar. Pirámide. https://tinyurl.com/2p9xysrv

Pineda-Roa, C. A., Navarro-Segura, M. C., & Moreno, A. (2021). Homonegatividad Internalizada en una Muestra Colombiana: Asociación con el Grado de Identificación con la Homosexualidad y las Variables Sociodemográficas. Revista Colombiana de Psicología, 30(2), 99–114. https://doi.org/10.15446/rcp.v30n2.80919

Powell, C. (2020). CGPfunctions: Powell Miscellaneous Functions for Teaching and Learning Statistics. R package version 0.6.3. https://tinyurl.com/5n8eczbu

R Core Team. (2021). R: A language and environment for statistical computing. R Foundation for Statistical Computing. https://www.R-project.org/

Ramón, L., Botha, K., Carrano, R., López, E., Savelev, I., & Tan, D. (2020). Homofobia de Estado 2020: Actualización del Panorama Global de la Legislación. Ilga World. https://tinyurl.com/5yvu44js

Reback, C. J., & Shoptaw, S. (2014). Development of an evidence-based, gay-specific cognitive behavioral therapy intervention for methamphetamine-abusing gay and bisexual men. Addictive Behaviors, 39(8), 1286–1291. https://doi.org/10.1016/j.addbeh.2011.11.029

Santiago, M., & Toro-Alfonso, J. (2010). La cura que es (lo)cura: Una mirada crítica a las terapias reparativas de la homosexualidad y el lesbianismo. Salud & Sociedad, 1(2), 136–144. https://doi.org/10.22199/S07187475.2010.0002.00007

Serrato Guzmán, A. N., & Balbuena Bello, R. (2015). Calladito y en la oscuridad. Heteronormatividad y clóset, los recursos de la biopolítica. Culturales, 3(2), 151–180. https://tinyurl.com/yc6nzcmb

Shadish, W. R., Matt, G. E., Navarro, A. M., Siegle, G., Crits-Christoph, P., Hazelrigg, M. D., Jorm, A. F., Lyons, L. C., Nietzel, M. T., Robinson, L., Prout, H. T., Smith, M. L., Svartberg, M., & Weiss, B. (1997). Evidence that therapy works in clinically representative conditions. Journal of Consulting and Clinical Psychology, 65(3), 355–365. https://doi.org/fjp5s8

Shalom, J. G., & Aderka, I. M. (2020). A meta-analysis of sudden gains in psychotherapy: Outcome and moderators. Clinical Psychology Review, 76, 101827. https://doi.org/ggkhz7

Shoptaw, S., Reback, C. J., Peck, J. A., Yang, X., Rotheram-Fuller, E., Larkins, S., Veniegas, R. C., Freese, T. E., & Hucks-Ortiz, C. (2005). Behavioral treatment approaches for methamphetamine dependence and HIV-related sexual risk behaviors among urban gay and bisexual men. Drug and Alcohol Dependence, 78(2), 125–134. https://doi.org/bkdpqf

Taller de Comunicación Mujer. (2019). Terapias de deshomosexualización en Ecuador: El patrón de impunidad por motivos de orientación sexual e identidad de género. Corporación Promoción de la Mujer/Taller de Comunicación Mujer. https://tinyurl.com/yxnkr9kb

Tang, T. Z., & DeRubeis, R. J. (1999). Sudden gains and critical sessions in cognitive-behavioral therapy for depression. Journal of Consulting and Clinical Psychology, 67(6), 894–904. https://doi.org/10.1037/0022-006X.67.6.894

Torres, C. A., & Rodrigues, D. L. (2021). Heteronormative Beliefs and Internalized Homonegativity in the Coming Out Process of Portuguese and Turkish Sexual Minority Men. Sexuality Research and Social Policy. https://doi.org/10.1007/s13178-021-00582-x

Trujillo, A., Feixas, G., Bados, A., Garcia-Grau, E., Salla, M., Medina, J. C., Montesano, A., Soriano, J., Medeiros-Ferreira, L., Canete, J., Corbella, S., Grau, A., Lana, F., & Evans, C. (2016). Psychometric properties of the spanish version of the clinical Outcomes in routine evaluation–Outcome Measure. Neuropsychiatric Disease and Treatment, 12, 1457. https://doi.org/10.2147/NDT.S103079

Winkler, M. I., Villarroel, R., & Pasmanik, D. (2018). La promesa de confidencialidad: Nuevas luces para la investigación científica y la práctica profesional en salud mental. Acta Bioethica, 24(1), 127–136. https://doi.org/10.4067/S1726-569X2018000100127

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